WARM HANDOFFS: A STRATEGY TO IMPROVE END-OF-ROTATION CARE TRANSITIONS AMONG HOUSESTAFF
Abstract Number: 264
Hospitalized medical patients transitioning to new house staff at the end of an inpatient resident rotation are associated with an increased risk of mortality as compared with patients not exposed to such handoffs, yet no data exist on improvement strategies targeting this transition. Given the frequency with which residents rotate service, a transition in care protocol, termed “warm handoff,” was implemented to make care transitions safer for patients. Modeled after shift transitions in the military, the warm handoff involves the transfer of clinical care at the patients bedside with the transferring physician directly introducing the patient to the receiving physicianMethods:
In July 2015, a one-hour training session was completed with PGY2 and PGY3 residents to teach them how to perform a warm handoff, whereby the incoming and outgoing residents meet at the hospital to sign out patients in-person. Additionally, focused bedside rounds occurred using a specially designed warm handoff checklist for resident-identified “sicker” or high-risk patients. Previously, end-of-rotation handoffs were conducted through a combination of verbal and written handoff without the requirement for in-person communication. Ten months post-intervention, we surveyed residents to assess the impact of warm handoffs during care transitions.
Results: Among 99 residents who underwent warm handoff training, 60 completed the survey, of which, 98% acknowledged that end-of-rotation transitions represent a vulnerable time for patients. The survey confirmed that prior to the intervention, only 5% of residents conducted in-person handoff at the bedside or hospital. After implementation of warm handoffs, 92% of residents participated in warm handoffs at least half the time during end-of-rotation transitions, and 85% perceived warm handoffs to be safer for patients (p <0.001). Among these residents, 98% indicated warm handoffs improved their knowledge and comfort level of patients (p<0.001) on the first day of a new rotation as compared to prior signout techniques. 95% of residents surveyed acknowledged that warm handoffs required additional time as compared to prior signout techniques; however, 88% signified they were worthwhile despite requiring additional time (p<0.001).
Conclusions: Warm handoffs represent a novel strategy to potentially mitigate the risk associated with end-of-rotation transitions in care. Residents overwhelmingly responded that warm handoffs resulted in perceived safer handoffs and that the additional time required to perform warm handoff was worthwhile. Although the impact of warm handoff on patient outcomes is unknown, the resident survey results are encouraging and suggest care transitions are safer.
To cite this abstract:
WARM HANDOFFS: A STRATEGY TO IMPROVE END-OF-ROTATION CARE TRANSITIONS AMONG HOUSESTAFF.
Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev..
Journal of Hospital Medicine Volume 12 Suppl 2.
July 12th 2020.