Teaching Video: "Handoffs: A Typical Day on the Wards"
|8331||February 17, 2011||1|
This teaching video represents a worst-case communication failure scenario based on a string of common, yet avoidable pitfalls in patient handoffs as documented in our body of research. This resource has been utilized to instruct undergraduate and graduate medical education trainees on the barriers and facilitators to effective care transitions. This workshop can be offered either within a cultural competency curriculum or quality and safety curriculum.
This case exposes trainees to the many sources that contribute to communication failure. In this workshop, learners work to define the contributors to and consequences of communication failure. The overall objective of these sessions is to emphasize effective provider behaviors to prevent threats to patient safety during transitions of care. When used in conjunction with the accompanying checklists and educational resources, this session arms residency program directors with a viable and interactive option for fulfilling the 2010 ACGME mandates which require residency programs to ensure resident competency in handoff communication.
Note: This resource consists of separate pieces of content. You may need to access via website, download resource files and/or request additional information from MedEdPORTAL staff to access the full publication.
Arora V, Farnan J, Paro J, Vidyarthi A, Johnson J. Teaching Video: "Handoffs: A Typical Day on the Wards". MedEdPORTAL Publications; 2011. Available from: https://www.mededportal.org/publication/8331 http://dx.doi.org/10.15766/mep_2374-8265.8331
- To identify major cultural, communication and environmental barriers to effective care transitions.
- To recognize and manage obstacles to delivering quality care.
- To identify and describe how systems-based issues contribute to patient handoff errors.
- To identify the pertinent patient history that should be communicated between providers during the transition of care.
- Internal Medicine
Interpersonal & Communication Skills
Patient Safety/Medical Errors
Problem-based Learning (PBL)
- Clinical Skills/Doctoring
- Medical Student
Professional School Post-Graduate Training
Authors & Co-Authors
Vineet Arora, MD, MA
University of Chicago Division of the Biological Sciences The Pritzker School of Medicine
Jeanne M. Farnan, MD MHPE
University of Chicago Pritzker School of Medicine
Arpana Vidyarthi, MD
University of California San Francisco
John A.M. Paro, MD
Julie K. Johnson, MSPH PhD
University of New South Wales
Sponsorship or Funding Source
This research was supported by: Agency for Healthcare Research and Quality Centers for Education Research on Therapeutics [R03HS018278 (PI Arora) and 1U18HS016967-01 (PI Meltzer)] American Board of Internal Medicine Foundation University of Chicago Department of Medicine
Effectiveness and Significance
A method for raising awareness of barriers to effective handoff communication by focusing on the implications these barriers can have on patient safety.
Special Implementation Guidelines or Requirements
This workshop is designed for large group settings (between 20-100 participants). Prior to workshop, distribute blank checklists to participants. After the video, start debriefing. Faculty facilitators may choose to incorporate the following points in their discussions:
- Does this actually happen? Highlight for the audience that this case is based on a an actual clinical scenario.
- What barriers did they observe? Use white board / flip chart and write the names of the 3 categories.
- What went well in the scenario?
- [OPTIONAL if time] Ask what could have done better to facilitate strategies if you have time.
- Distribute completed checklist and discuss issues which were not offered by audience.
This workshop has been conducted at grand rounds and health policy forums across the country. We have since been contacted by residents and faculty from several institutions who found this approach to teaching handoff quality useful in complementing and improving didactic approaches to clinical practice. Additionally, discussions generated from this video are currently informing the development and implementation of a core curriculum for teaching handoff quality to students and residents.
Strengths of Tool: “The greatest strength of this educational resource is its universality; it can be tailored to complement any curricula for all levels of learners. The accompanying checklists confirm internalization of issues raised in the video and encourages group discussion.”
Shortcomings of Tool: “This tool is limited in that it is not an exhaustive resource on patient care transitions, but a snapshot of the process and, as such, captures only some of the systems-related handoff issues (computer availability, professionalism, competing factors/workload). This current resource focuses on identification of barriers to the process; future work serves to aim to elucidate best practices and effective communication styles. In fact, the establishment of milestones for handoff education by studying the development of skills acquired through undergraduate and graduate medical education will further assist in tailoring future educational products.”
This information is made available under the Creative Commons license.
Publications, Presentations, and/or Citations for this Publication
- Arora VM, Johnson J, Lovinger D, Humphrey H, Meltzer D. Communication Failures in Patient Signout and Suggestions for Improvement: A Critical Incident Analysis. Qual Saf Health Car. 2005;14:401-7. http://dx.doi.org/10.1136/qshc.2005.015107
- Arora VM, Johnson J. A Model for Building a Standardized Hand-Off Protocol. Jt Comm J Qual Patient Saf. 2006;32(11):646-655.
- Vidyarthi A, Arora VM, Schnipper K, et al. Managing Discontinuity in Academic Medical Centers: Strategies for a Safe and Effective Resident Sign-Out. J Hosp Med. 2006; 1(4): 257-266. http://dx.doi.org/10.1002/jhm.103