Our 90-minute workshop increased interns' self-reported knowledge, behavior, and readiness to conduct handoffs during their first 6 months of residency. Since it took place during orientation, all interns participated, and key points were easily reinforced in a follow-up morning report. It required minimal materials and technology, was interactive, and allowed for a variety of adult learning styles.
Previous handoff training techniques published in the literature have used didactic techniques, simulation, or attending physician oversight.15–,17
Simulation strategies and physician oversight are excellent ways to reinforce and perpetuate best practices. Our training intervention was highly interactive, did not require specialized facilities or paid actors, was inexpensive, and conveniently inserted into orientation and existing teaching activities, and could be replicated with minimal materials and faculty.
Our workshop created a flexible framework for interns to understand the content, communication, and environmental factors influencing handoffs.7–,9
It emphasized interpersonal skills such as active listening, questioning assumptions, and delegating responsibility for patient care. Specifically, we framed handoffs as a dialogue between team members and highlighted the important roles of both the giver and receiver of the handoff in the creation of a shared mental model. The workshop allowed interns to practice skills and apply lessons learned in a selective and thoughtful manner. In addition, we provided them with scripts for dealing with common situations. For example, when a nurse interrupts a handoff with a question about a patient, we suggested the resident say, “I'm handing off a patient right now, as soon as I'm done I'll find you.” Contingency planning and active listening were commonly mentioned as becoming a new part of handoff practice among workshop participants.
Studies suggest a correlation between confidence and self-assessment and the likelihood of attempting to apply knowledge and skills.18–,20
We believe participants in our workshop who said their readiness had increased are more likely applying the skills they learned in real-world settings.21,22
Self-reported behaviors after a commitment to change statement, following a continuing medical education workshop, have been shown to be accurate representations of subsequent behavior.23
Our follow-up survey data support this conclusion, since most participants said they incorporated aspects of the workshop into their handoffs.
Our study had several limitations. First, we did not measure patient safety outcomes, in part because linking adverse events to deficient handoffs is difficult. We did bring awareness, general knowledge, and understanding of handoffs to a common level, which is a necessary first step in any patient safety intervention. Second, assessment of the workshop was done using a pretest/posttest methodology, which could cause bias in the direction of more readiness after training. Third, although nearly all the interns reported incorporating techniques learned in the workshop into practice, the low response rate may have introduced respondent bias. Fourth, our measurement of the workshop's effectiveness was by self-report and may differ from interns' performance in practice. Fifth, our follow-up period was relatively short and the positive effect may not have been sustained or may be superseded by the prevailing culture around handoffs.
Our next steps are to further define best handoff practices and directly observe the handoff skills of workshop participants by using a scoring rubric at some time after training, and to provide additional handoff training in the second or third years of residency. We want to include more senior residents in the teaching and assessment process to further improve their skills with patient handoffs.
Our results show that a brief interactive workshop can improve resident's self-reported readiness and behavior around handoffs.