Methods The team used seven different methods to understand and standardize the Department of Surgery handoff process: literature search, observations, time studies, interviews, surveys, tally cards, and a pilot study. Literature Search The team performed a literature search and compiled eight research papers to gather information on standardized handoffs at other institutions. From the information, the team determined best practices, such as specific areas of patient care to include in the patient handoff. These best practices were incorporated into the recommendations to the Department of Surgery. Observations and Time Studies The team observed the Department of Surgery’s current handoff process between the day and night shift residents. The team used observations in conjunction with other forms of data collection to propose changes to the current process. Furthermore, the information collected in the time studies was used to ensure that the new process is not significantly longer than the current process. Five pre-pilot observations were completed and four post-pilot observations were performed to assess the effectiveness of the changes. To perform observations, the team received resident contact information from the client and contacted the resident on call upon arrival at the hospital. During observations, the team members performing the observations also performed simple time studies. The team recorded the amount of time the handoff process took and the number of patients that were discussed. The team used this information to determine the average time spent discussing one patient during a handoff. Interviews The team conducted preliminary interviews with six resident surgeons and one attending surgeon. Three of the residents were in their third year of residency, two were in their fourth year, and one was a chief (seventh year) resident. The interviews were conducted to better understand the goals of residents during the handoff process and to gather recommendations to improve that process. The preliminary interviews were conducted individually, with each team member interviewing only one resident at a time. The questions that were discussed in this interview can be found in Appendix A. Team members audio recorded each interview and listened to the recordings later, taking detailed notes. Along with the free response sections of the survey, the interview data was used to better understand concerns of the residents and gather subjective recommendations. After implementation of the pilot, the team performed four more pilot interviews to receive feedback on the proposed method. The questions asked in the pilot interview can be seen in Appendix E. More detail on the pilot interviews will be covered in the pilot section of this report.
7. On average, how often do the following events occur as a result of signout events? # Question Rarely Occasionally 1-3 times per shift 4 or more times per shift Total Responses Mean 1 Missing patient information 0 15 9 0 24 2.38 2 Miscommunication about patient information 2 15 7 0 24 2.21 3 Delay in patient care 3 17 4 0 24 2.04 4 Adverse health event for patient 17 7 0 0 24 1.29 Statistic Missing patient information Miscommunication about patient information Delay in patient care Adverse health event for patient Min Value 2 1 1 1 Max Value 3 3 3 2 Mean 2.38 2.21 2.04 1.29 Variance 0.24 0.35 0.30 0.22 Standard Deviation 0.49 0.59 0.55 0.46 Total Responses 24 24 24 24
2. How often did the following events occur as a result of the proposed signout method? # Question Rarely Occasionally 1-3 time per shift 4 or more times per shift Total Responses Mean 1 Missing patient information 0 1 0 0 1 2.00 2 Miscommunication about patient information 1 0 0 0 1 1.00 3 Delay in patient care 1 0 0 0 1 1.00 4 Adverse health event for patient 1 0 0 0 1 1.00 Statistic Missing patient information Miscommunication about patient information Delay in patient care Adverse health event for patient Min Value 2 1 1 1 Max Value 2 1 1 1 Mean 2.00 1.00 1.00 1.00 Variance 0.00 0.00 0.00 0.00 Standard Deviation 0.00 0.00 0.00 0.00 Total Responses 1 1 1 1