A pilot study to standardize and peer-review shift handoffs in an academic internal medicine residency program: The DOCFISH method

With increased oversight of residency work hours, there has been an increase in shift handoffs, which are prone to medical errors. To date, there are no evidence-based recommendations on essential elements of shift handoffs. We implemented a standardized shift-handoff rubric at an academic medicine...

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Bibliographic Details
Published in:Medicine (Baltimore) 2018-10, Vol.97 (41), p.e12798-e12798
Main Authors: Krowl, Lauren, Gudlavalleti, Aashrai, Patel, Arpan, Panebianco, Lauren, Kosters, Michael, Dhamoon, Amit S.
Format: Article
Language:English
Subjects:
Academic Medical Centers - organization & administration
Academic Medical Centers - standards
Attitude of Health Personnel
Hospital Rapid Response Team - statistics & numerical data
Humans
Internal Medicine - education
Internship and Residency - organization & administration
Internship and Residency - standards
Patient Handoff - organization & administration
Patient Handoff - standards
Patient Safety - standards
Perception
Pilot Projects
Quality Improvement - organization & administration
Quality Improvement Study
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Summary:With increased oversight of residency work hours, there has been an increase in shift handoffs, which are prone to medical errors. To date, there are no evidence-based recommendations on essential elements of shift handoffs. We implemented a standardized shift-handoff rubric at an academic medicine residency program. Compliance, resident/faculty perceptions, and surrogate markers of patient safety were measured.Shift-handoff documents were collected January-February 2016 (control) April-June 2016 (intervention). Signouts were scored based on inclusion of seven elements: Daily events, Overnight events, Code status, Follow up tasks, If/then statements, 'sick or stable' and History present illness. The mnemonic 'DOCFISH' was taught in a grand-rounds forum then embedded into a shift-handoff tool within our electronic health record (EHR). Senior residents were assigned to supervise/provide feedback on shift handoffs from April-June 2016. Faculty and resident perceptions regarding quality of shift handoffs was measured by the annual ACGME (Accreditation Council Graduate Medical Education) program survey.Patient safety was measured by number of rapid-response teams (RRT) initiated for unstable vital signs. Handoffs were 74% complete in intervention group and 60% in control group (p 
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000012798