BONNIE C. DESSELLE, MDPROGRAM DIRECTOR

LSUHSC PEDIATRIC RESIDENCY PROGRAM

Strategies and Tools to Enhance Communication Among Health

Care Providers

Communication Series

Part 1: Hand – offsPart 2: Formal PresentationsPart 3: Communication during Emergencies

Hand - Offs

Mechanism of transferring information, responsibility and/or authority from one set of care-givers to another

Sentinel Events

Root Causes of Sentinel Events(1995-2005) -The Joint Commission of Accreditation of Hospitals

Organization culture

Care planning

Continuum of care

Leadership

Environ. Safety/security

Procedural compliance

Competency/credentialing

Availabilty of info

Staffing

Patient assessment

Orientation/training

Communication

0 10 20 30 40 50 60 70

Call to Improve Handoffs

Joint Commission, 2006 National Patient Safety Goal

World Health Organization, 2006 Prevention of handover errors part of “High Fives” patient

safety solutionsInstitute of Medicine, 2008

Teaching programs “should train residents in how to hand over their patients using effective communication.”

ACGME, 2010 Programs must ensure and monitor effective, structured

hand-over processes Must ensure that residents are competent in the hand-over

process

Group Discussion

Characteristics of Worst and Best

Sign-offs

Group Discussion

Live demonstrations of sign-offs

Essential Elements for Pediatric Sign-out List

Demographics Name MRN Unit/room number Age Weight Gender Allergies Admit date

Attending physician/Service/Consults Phone numbers and covering physician

History and Problem List Primary diagnosis(es) Chronic problems (pertinent to this admission/shift)

Current condition/status

Essential Elements for Pediatric Sign-out List

System based Pertinent Medications and Treatments

Oral and IV medications IV fluids Blood products Oxygen Respiratory therapy interventions

Pertinent lab dataTo do list

Check x-ray, labs, wean treatments Include rationale

Essential Elements for Pediatric Sign-out List

Contingency Planning What may go wrong and what to do

If this…then do this Include rationale What has/ has not worked before (e.g. responds to nasal

suctioning)

Code status/family situations Difficult family or psychosocial situations Code status, especially recent changes or family

discussions

Practice a sign out

Essential Elements for Receiver

Readback/Summation: co-orientationQuestions/clarificationsCollaborative cross check

Other Essential Elements

Proper Environment: sterile cockpit No distractions Quiet place Always face to face

Start with sickest patientNever say “ This is not my patient….I am just

covering for the night”

PGY- 1

Essential Elements of Sign-out Giver Mastery Patient identification Patient background Current conditions or current physical exam Contingency plans Overall general treatment plan

PGY-2

3 Essential Elements for Sign-out Receiver Mastery Readback/summation: Co-orientation Questions/clarifications Solicit other overnight tasks for patient

PGY-3

Has mastered giving and receiving sign-outWorking towards:

Collaborative cross checkOff topic discussion that include teaching

points

Summary

Effective exchange of information is vital during sign-outs

Both the giver and receiver have specific roles and responsibilities

Hopefully we have given you some tools to make your hand-offs more effective

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