Teaching Residents Effective Transitions of Care: Examining the Patient Handover from Admission to Discharge

Background:

Patient handovers represent vulnerable points in time during a hospitalization. Although changes in the practice of medicine and changes in residency work‐hour restrictions have led to increased patient handovers, training programs have not uniformly addressed measures to improve patient safety during these critical handover events. In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) will incorporate transitions of care into resident core competency requirements, emphasizing the need to integrate structured and effective resident handover communication within medical training.

Purpose:

We designed a novel care transitions curriculum to strengthen and standardize internal medicine resident handover communication during at least 5 distinct types of patient handovers that occur throughout the inpatient care setting. Assessment of effective patient handover principles and resident performance evaluation are planned for each of these transitions of care.

Description:

The handovers curriculum interactively teaches principles of communication at each transition of care during the hospitalization: (1) emergency room to medicine ward admission, (2) night float admission, (3) nightly handover, (4) intensive care unit transfer, and (5) hospital discharge. The curriculum consists of an interactive didactic component—outlining care transitions principles through core lecture series, instructional videos, and handout materials and a resident handover evaluation component—with feedback using standardized evaluation tools and a team‐based approach. Trainees receive a pocket card that reinforces key concepts at each transition and utilizes a mnemonic, “2‐HANDOVER,” to guide residents in structured communication. Curriculum videos examine relevant pitfalls that may occur during care transitions and demonstrate effective communication strategies during each patient handover. Initial institutional and individual feedback of our curriculum has been met with optimism and broad approval. Preliminary resident assessments have identified trainee deficiencies that we believe will be mitigated by the curriculum and likely improved postassessment.

Conclusions:

In this era of increasing patient handovers, training programs require a robust transitions‐of‐care curriculum to ensure patient safety and quality across the care continuum. Pre‐ and postcurricular evaluation of resident perceptions and transitions‐of‐care practices will lead to refinement of the curriculum and optimization of outcomes.

Disclosures:

C. Payne ‐ none; M. Eskildsen ‐ none; K. Galpin ‐ none; J. Bonsall ‐ none; K. Manning ‐ none; J. Stein ‐ none; D. Dressler ‐ none