Implementing a Comprehensive Handoff Program to Improve Pediatric Patient Safety

Study Overview
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Brief Summary
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The investigators propose to test the hypothesis that implementation of a comprehensive handoff program (CHP) - i.e., implementation of a computerized handoff tool along with teamwork training for pediatric residents on inpatient units at Children's Hospital Boston - will lead to reductions in resident miscommunications / medical errors and improvements in workflow and experience on the wards.

Detailed Description
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Following collection of baseline data on two inpatient pediatric wards, teamwork training is to be provided to all pediatric residents. On our primary intervention unit, this will be accompanied by the introduction of a new computerized handoff tool that facilitates accurate transmission of data. The effects of this combined intervention on safety and workflow will be assessed on the primary intervention ward as compared with the historical control unit and the concurrent unit that received teamwork training without the computerized tool.

Official Title
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Implementing a Comprehensive Handoff Program to Improve Pediatric Patient Safety

Conditions
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Patient Safety, Resident Workflow, Resident Experience

Intervention / Treatment
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* Other: Computerized handoff tool
* Other: Team training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all residents working on study units during study period, except as below Exclusion Criteria: residents on the teamwork only unit who have previously been on the primary intervention unit

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Computerized Handoff Tool plus training<br>Computerized handoff tool implemented together with team training for residents | Other: Computerized handoff tool<br>* Informatics tool to aid in transfer of patient care information<br>Other: Team training<br>* Teamwork training and revisions of handoff structure to optimize teamwork skills and verbal communications<br>|
| Active Comparator: Team training only<br>No computerized tool | Other: Team training<br>* Teamwork training and revisions of handoff structure to optimize teamwork skills and verbal communications<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rates of resident-related communication and total medical errors | Resident-related medical errors (including medication-related, diagnostic, and procedural) detected using a multi-pronged prospective surveillance methodology that involves 5d/week chart review, review of hospital incident reports, and collection of staff reports. Resident-related defined as involving a resident research subject. Communication errors are those medical errors attributable to communication failures. | July 2010 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rates of total medical errors | As above, but includes both those errors involving residents and those involving all other clinical personnel. | July 2010 | 
| Minutes residents spend updating the signout; minutes spent in direct patient care; minutes spent working at computer |  | July 2010 | 
| Resident reported experience of care | Self-reported, Likert scales on survey instruments. | July 2010 | 
| Rates of verbal miscommunications | Detected by direct observation, audio recording, then rating using study instrument developed for this purpose. | July 2010 | 
| Rates of written miscommunications | Detected by detailed review of written signouts, rated using study instrument developed for this purpose. | July 2010 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Patient Safety, Medical Errors, Handoff, Sign-out, Resident, Intern, Graduate Medical Education