Patient Handoff Among General Surgery Residents in Saudi Arabia: A Cross-Sectional Study

Background Communication failure is a common cause of adverse events. An essential element of communication among healthcare providers is patient handoffs. To explore this practice, we assessed patient handoffs among general surgery residents in Saudi Arabia. Methods A cross-sectional survey was conducted with individuals in accredited general surgery residency programs in Saudi Arabia between 2020 to 2021. Results Participants comprised 118 general surgery residents—66 (57.3%) were females; 67 (72.8%) did not receive any formal training on patient handoff; 35 (38.8%) reported that they were sometimes interrupted during the patient handoff process. The most common reason for such interruptions was medical personnel paging. Further, 60 (68.1%) general surgery residents stated that such interruptions led to a decreased quality of effective communication, 39 (44.3%) believed it led to decreased quality of patient care, 63(71.5%) believed it led to the loss of some information related to patient handoff, and 16 (18.1%) believed it led to patient harm. Finally, 31 (34.4%) general surgery residents believed that the existing handoff system at their institutions neither adequately protected the patient’s safety nor allowed for continuity of care; and 51 (68%) reported that they did not have a standardized protocol for patients’ verbal handoff process at their institution. There were higher proportion of patients with minor harm in residents who did not, rare or some time received verbal or written hand off (67% vs 33%). Conclusion The patient handoff process among general surgery residents in Saudi Arabia is subjective, not standardized, and can contribute to patient harm. Standardizing it is paramount to improve patient safety.

The effect of distraction on the quality of patient handoff: a randomized study*

Objective The number of patient handoffs has increased in recent years. In addition, technology has advanced in the medical field, leading to most providers carrying smartphones at work. Little is known about the effect of mobile devices and quality of patient handoffs. The objective of this study was to determine whether distraction affects the quality of sign-out among obstetrical providers. Design A randomized, prospective study was conducted. Setting Hospital. Participants Intervention Obstetrical providers listened to a recorded sign-out vignette. Provider groups either were or were not exposed to a distraction while listening to the vignette. All providers had been told that they would be participating in a trial of two methods of sign-out, although in actuality they were all assigned to a single method. In the distraction arm, the participants were exposed to a ‘distracting event’ (a phone ring, which was answered by the proctor and followed by a brief conversation) that occurred midway through the vignette. Main Outcome Measure Providers answered a 14-question survey testing recall of facts included in the vignette. The results of each group were analyzed using Fisher’s exact test and Student’s t-test. Results Eighty-eight providers were randomized, 44 in the distraction group and 44 in the non-distracted group. The average scores on the survey were similar between groups (11.0 and 10.8, P = 0.57). In addition, the average scores for questions that occurred after the distraction did not differ between the distracted and non-distracted groups (6.4 vs 6.2, P = 0.42). Conclusions We observed that a phone ring and brief response did not affect the obstetrical providers’ recall of details of a standardized sign-out. More studies are warranted to determine if more frequent or longer distractions would change results.

Standardizing Sign-out With I-PASS Handoff in Family Medicine Residency

Introduction: Handoff miscommunications are a leading cause of medical errors. A structured handoff is an effective communication tool. We introduced the I-PASS Handoff Bundle for resident sign-out in the inpatient setting. We aimed to reduce preventable adverse events and unexpected floor calls while also improving residents’ confidence and preparedness to care for patients overnight. Methods: We conducted an observational study at a single-site family medicine residency between April 2019 and March 2020. Residents received trainings in the I-PASS standardized handoff through didactic lectures and on-the-job sessions in September and November 2019. We evaluated the effectiveness of the I-PASS Handoff Bundle by comparing pre- and postimplementation data including number of medical errors and unexpected floor calls, along with residents’ reported levels of preparedness and confidence to care for patients overnight. Results: Prior to the I-PASS intervention, more than half of resident surveys included at least one unexpected floor call whereas postintervention about one-third of resident surveys included unexpected floor calls (P<.05). However, the intervention did not significantly affect residents’ confidence level in caring for patients overnight and residents’ rating of the usefulness of anticipatory guidance for managing night floor calls. We did not identify any medical errors related to communication issues at patient handoff within the family medicine service. Conclusion: I-PASS intervention significantly reduced unexpected floor calls. However, the intervention did not improve residents’ reported confidence and preparedness to care for patients overnight.

Avoiding Fumbles: Online Patient Handoff Training

Introduction: The COVID-19 pandemic required rapid curriculum adaptation to online delivery. Given the importance of accurate clinical patient handoffs, we adapted simulation-based medical student training in clinical patient handoffs. We scored the accuracy of the information students presented. We also elicited student feedback to determine their perceptions of the event and their evaluations of the effectiveness of the training. Methods: Twenty-six third-year medical students participated online via Zoom. Students participated in groups of three or four students. They sequentially encountered a standardized patient. Clinical information and physical exam findings were handed off from student to student until the encounter was complete. The student group then debriefed with faculty. Students were evaluated based on the proportion of clinical information handed off to the following student. Students also evaluated the training session. Results: The first student handoff included 73.4% of the available information. In subsequent handoffs, the percentage fell to 43%. All students said they felt the training was helpful in practicing patient handoffs and interactions with colleagues. Negative student comments focused on perceived deficiencies in session planning and standardized patient training. Conclusions: This rapidly developed simulation session demonstrated that clinical training in patient handoffs can be adapted to an online environment. In order to ensure success, faculty should carefully consider logistical adjustments required to transition from a patient contact setting to an online environment. Meticulous preparation and attention to detail will ensure that training is successful.