WIP 08 - Improving Patient Handoff Between Residents from the Pediatric Emergency Department to the Pediatric Floor

Publication Number: WIP 08.7602

Katja Anuth, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Jeremy Silverstein, Maimonides Infants and Children's Hospital of Brooklyn, New York, NY, United States; Stephanie Aronson, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Rachel Leib, Maimonides Infants and Children's Hospital of Brooklyn, New York, NY, United States; Stacie Kahn, Maimonides Infants and Children's Hospital of Brooklyn, New York, NY, United States; Mehbeen Khan, Maimonides Infants and Children's Hospital of Brooklyn, brooklyn, NY, United States

Background: Communication failure is one of the most common causes of medical errors and near misses. A critical juncture of a child's inpatient stay at a hospital occurs during the handoff between the Pediatric Emergency Department (PED) and Pediatric Inpatient Unit (PIU). At our hospital, this handoff is made between a PED resident and a 3rd year resident in the PIU. As this occurs between trainees, without supervision, organized and standardized handoff tools are necessary to ensure appropriate communication and improve patient safety. Residents were surveyed on their experience and confidence with handoffs. Most reported feeling only somewhat confident in their knowledge of what should be included during a handoff. Two attending physicians observed handoffs and found critical information missing during this exchange between trainees.

Objective: Objectives are to improve the overall quality of handoffs between the PED and PIU using a handoff tool (HT). Our SMART AIM is: 1. Increase use of the HT for 90% of all handoffs in 8 months. 2. Increase the amount of information filled in on the HT to 80% of requested information in 8 months.

Design/Methods: We designed the HT with input from attending and resident physicians to incorporate the necessary information for an efficient handoff. Once developed, we started our PDSA cycles. In our 1st cycle, HT was given to the admitting seniors to use as a guide to ascertain missing information when receiving handoff. In our 2nd cycle, PED residents were provided with the HT to use as a checklist while providing handoff. In our 3rd cycle, we edited the HT allowing the admitting senior to transcribe information directly on to it. In our 4th cycle, we revised the HT to include checkboxes to indicate if specific information in the tool is relevant or not applicable to the patient being signed out.