Handing Down the Hand-Off
What is a Hand-Off?
http://www.flickr.com/photos/cavalierhorn/3938109498/
Why is it
important?
Amanda Cegielskihttp://www.flickr.com/photos/thatpicturetakr/3148936883/
Variable Odds Ratio for Preventable Adverse Events
Cross-Covering Physician 6.1
APACHE II Score 1.2
History of GI Bleeding 4.7
Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Annals of Internal Medicine. 1994;121(11):866-872.
Arielle Fragassihttp://www.flickr.com/photos/toastytreat/4555895229/
1)Frank G, Lawler L, Jackson A, Steinberg T, Lawless S. Resident miscommunication: Accuracy of the resident sign-out sheet. J Healthc Qual. 2005;27(2). 2)Arora V, Kao J, Lovinger D, Seiden SC, Meltzer D. Medication discrepancies in resident sign-outs and their potential to harm. Journal of general internal medicine. 2007;22(12):1751-1755.3)Aylward M, Rogers T, Duane P, Inaccuracy in Patient Handoffs: Discrepancies between Resident-Generated Reports and the Medical Record, Minn. Med. 2011; 94(12) 38-41.
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Photo by: Michael Aylward
1)Kitch BT, Cooper JB, Zapol WM, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Joint Commission journal on quality and patient safety / Joint Commission Resources. 2008;34(10):563-570.2)Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Archives of Internal Medicine. 2006;166(11):1173-1177.
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A Tao of the Hand-Off
Environment
Photo by: Michael Aylward
ANTICIPATE
SBAR
AIDET
ASHICE
DeMIST GRRRRHANDOFFS
I PASS THE BATONjust go NUTS
SBARSBAR
MIST
PACE
PEDIATRIC
SHARED
SHARQ
SIGNOUTSOAP
STICC
5P
4P Content
Triage
Tell the Story
Details on Demand
Contingency Plans and Concerns
Problem Statement:
name, age, sex, significant past medical history, main reason for admissions, highlights/important changes since admission.
Prioritize the patients:
RS=Really Sick
S=Sick
NS=Not Sick
Problems prioritized, relevant information given within context of person taking the hand-off.
Hand-off should be interactive, with questioning from accepting physician, two-way communication.
[ If...Then ]
Rupert Ganzerhttp://www.flickr.com/photos/loop_oh/3294984769
Diagram adapted from Baker DP, Salas E, King H, Battles J, Barach P. The role of teamwork in the professional education of physicians: current status and assessment recommendations. Joint Commission journal on quality and patient safety / Joint Commission Resources. 2005;31(4):185-202
Graphics by Michael Aylward
References
•All images used under Creative Commons license.