Title: The Otorhinolaryngology Hand-Off: Pursuing Excellence in Patient Care and Safety
1The Otorhinolaryngology Hand-OffPursuing
Excellence in Patient Care and Safety
- Mark A. Zacharek, MD, FACS, FAAOA
- Associate Professor
- Associate Residency Program Director
- Department of Otorhinolaryngology
- Michigan Sinus Center
- University of Michigan Health System
2ACGME Common Program Requirements
- Sponsoring institutions must ensure and monitor
effective, structured hand-over processes to
facilitate both continuity of care and patient
safety. Programs must ensure that residents are
competent in communicating with team members in
the hand-over process.
ACGME 2011 CPR www.acgme.org
3Halstead on Surgical Residency
- It will be objected that this is too long an
apprenticeship, that the young surgeon will be
stale, his enthusiasm gone before he has
completed his arduous term of service. These
positions are not for those who soon weary of the
study of their profession, and it is a fact that
the zeal and industry of these young assistants
seem to increase as they advance in years and as
their knowledge and responsibilities become
greater.
4The Otorhinolaryngology Hand-off
- ACGME standards promote teamwork.
- Residents must work effectively as a member or
leader of a health care team or other
professional group. - Residents are expected to work in
inter-professional teams to enhance patient
safety and improve patient care quality. - Residents should have representation on hospital
quality improvement committees.
ACGME 2011 CPR www.acgme.org
5Residents have Duty Hour Restrictions
- With a focus on restricted duty hours, the
importance of communication between teams and
individuals is of the utmost importance. - Bo Schembechler (1983)-
- The Team, The Team, The Team!
- The handoff (handover signout ) is part
of the continuity of care when one resident is no
longer in the hospital for a continuous period of
time.
6Definition Transitions of Care
ACGME 2011 CPR www.acgme.org
- Programs must design clinical assignments to
minimize the number of transitions in patient
care. - Responsibility for each patient may be
transferred between 2 or more residents within a
24 hour period. - Sponsoring institutions and programs must ensure
and monitor effective, structured handover
processes to facilitate both continuity of care
and patient safety. Programs must ensure that
residents are competent in communicating with
team members in the handover process.
7Can we standardize the otorhinolaryngology
handoff?
- Handoffs may occur asynchronously without person
to person/face to face interaction. - Reduction in errors due to fatigue should not be
offset by an increase in errors due to poor
communication/improper information transfer.
8Multiple types of Handoffs
- Post-op Ambulatory
- Inpatient consult
- Outpatient/clinic
- Primary Oto inpatient service
- Primary Oto SICU patient in closed ICU system
(General Surgery Staff and Resident) - Different Otolaryngology Services (Neurotology,
Head and Neck, VA, Pediatric) - Multiple Hospitals (Home Call vs In House)
9Program Director Strategies
- Supervision and provision of feedback
- Coaching (Senior resident and faculty observation
of junior handoffs) - Objective skills-based examinations
- Simulation of practice handoff skills
- Metrics in Portfolio for Interpersonal Skills
and Communication - Using a checklist?
- What do other professionals do?
10Causes of Error in Teaching Hospitals
- Between 1979-2001, closed malpractice claims data
- 240 errors in teaching settings
- - errors in judgement 72
- - problems with teamwork 70
- - lack of technical competence 58
Singh H et al. Medical errors involving trainees
a study of Closed malpractice claims for 5
insurers. Arch Intern Med. 2007167(19)2030-2036
11Transitions of Care in the Training Environment
ACGME Standards
- Dr. Bradley Marple, MD Dr. Marple is Professor
and Vice Chairman of the Department of
Otorhinolaryngology-Head and Neck Surgery at the
University of Texas Southwestern. Additionally,
he is the Chair of the ACGME Otolaryngology
Residency Review Committee.
12Patient Handoffs A Cognitive Systems Engineering
Perspective
- Emily Patterson, PhD Dr. Patterson is an
assistant professor at Ohio State University in
the Health Information Management and Systems
Division of the School of Allied Medical
Professionals in the College of Medicine. She is
an expert in the field of cognitive systems
engineering with interests in health informatics
and macro-cognitive communication.
13Patient Hand-offs A Medical Education
Perspective
- Ingrid Philibert, PhD MBA Senior Vice
President, Department of Field Activities at the
ACGME. Dr. Philibert is responsible for the
Council's 31 MD and PhD accreditation field
representatives as well as the 2000 site visits
conducted annually. She is one of the editors of
the ACGME's recent monologue regarding Duty Hour
Standards "The ACGME 2011 Duty Hour Standards
Enhancing Quality of Care, Supervision, and
Resident Professional Development". -