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.