Embed Size (px)
Citation preview
Patient handoff simulation: Does formal training build skills and confidence in
transitions of patient care?
Daniel Relles, Renee Tholey, Christine Feldmeier, Richard Burkhart, Stacey Milan
Thomas Jefferson University, Philadelphia, PA
April 24, 2013
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Introduction
• Medical Errors:• Communication• Transitions in care
• Signout process >2x daily• Content vs Process
• Formal training and education focus on content
• No training on process, efficiency, or self-management
9 - 5
Terminology
Signout/Handoff
Can new interns be taught systems and strategies to prioritize and recall important patient updates?
“Running the List” RTL
Nightfloat
6 - 6
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
March 201226 27
Course Begin
28
SimMan
29 1 2 3
4 5 6 7 8
SimMan
9 10
11 12 13
SimMan
14 15
SimMan
16 17
18 19 20
SimMan
21 22 23 24
1 2
3
1 2
1 2Simulation Assessment 3 Training
Team Handoff Simulation
• End-of day, team “running the list”• Roles
• 6 - 8 Interns (MS4)• 1 Junior resident (faculty)• 1 Senior resident (faculty)
• Agenda• Activity overview (5 min)• Review of patients (5 min)• “Run the list” (30 min)
Team Handoff Simulation
• Task• 1 complex patient• 1 basic patient
“You are the intern, who will
sign out to night float after
we run the list.”
Materials
• Service List• Complex H&P• Basic H&P
Materials: Service List
Materials: H&P
Materials
• Service List• Complex H&P• Basic H&P
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Assessment: Urgent Issues
Assessment: Urgent Issues
Assessment: Routine Issues
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Training
• SimMan simulations
• Formal training
Formal Training
• ~45 minutes• Best practices from
PGY1 & PGY2
“What’s your system?”
• Techniques and strategies for patient management
• Help support efficiency, recall and prioritization
Formal Training• Coloring systems (black = run the list in black, blue =
update the list, red = issues to escalate)• Cross-out/check box/circle• Circle, squares, and underlines• Imaging: 3 boxes (ordered/completed/read)• Separate list: top priorities• Document every nursing page• Consistent spaces• Reduced printing• Create table; generate list of “things to do” per pt• Strategic folding
Formal Training
Formal Training
Formal Training
Formal Training
Formal Training
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Identification of Urgent Issues
n=21, p<0.05
Identification of Routine Issues
n=21, p<0.05
Overview
• Introduction• Methods
• Simulation• Assessment • Training
• Results• Conclusion
Conclusion• Described a simulation of a team signout and patient
handoff that is a useful adjunct to on-the-job training• Improved ability to identify and recall urgent and non-
urgent service issues• Helped build confidence in recall and prioritization
Contact: [email protected]
