Innovative Strategies That Improve Clinical Handoff (I‐Switch) Phase II: Randomized Controlled Trial Evaluating Educational Modalities Including Cognitive Simulation

Background:

Few studies have investigated how to optimally educate physicians on the cognitive skills required for effective clinical handoffs.

Methods:

A single‐institution, prospective, randomized, controlled trial was conducted to explore the effectiveness of different educational modalities to teach handoff skills. Thirty‐nine internal medicine interns were assigned to an interactive didactic workshop, an interactive didactic workshop combined with a cognitive simulation exercise, or the usual experiential teaching. A standardized handoff method utilizing the acronym I‐SWITCH (Identifiers, Severity of illness, Working problems, Interventions on anticipated problems, Tests/consults pending, Code status, History) was introduced during the didactic session. During the cognitive simulation, interns practiced their handoff skills using simulated clinical cases. Handoff performance was evaluated by PGY‐2 and PGY‐3 night‐float residents blinded to the interns' intervention allocation.

Results:

A total of 296 handoff interactions were scored among the 39 interns randomized revealing a trend toward improved handoff performance in the intervention groups compared with the control. Significant changes were seen among both intervention groups in confidence with verbal handoff and in satisfaction with handoff training following the interventions. Interns who participated in the cognitive simulation had an 8% improvement (P = 0.074) in objective handoff performance compared with the control. The surrogate clinical outcome — the number of handoff errors/intern/night, a reflection of key clinical content omission and failure to anticipate problems — was 0.48, 0.26, and 0.13 in the control, didactic, and didactic+simulation arms, respectively. This resulted in error reductions of 46% in the didactic arm over th control (P = 0.373) and of 70% in the didactic+simulation arm over the control (P = 0.074).

Conclusions:

Results of this single‐institution study suggest that standardized, structured handoff education coupled with simulation has favorable results on “real‐life” intern handoff performance.

Author Disclosure:

J. Han, none; A. L. Lukowski, none; P. Y. Watson, none.