title: Handing over patient care: is it just the old broken telephone game?
abstract: BACKGROUND
  Handing over patient care remains a poorly understood process and remains a leading cause of medical error. We sought to examine how hand off delivery methods affect hand off quality and whether improvement would occur over time without formal training.
  
  
  METHODS
  Three simulated-patient hand offs were developed; each with a distinct delivery method: in-person (IP), video-based (VB), and screen-based (SB). Participants were evaluated up to 4 times, each 6 months apart. During evaluations, residents received the 3 hand offs, answered a sleep and preference questionnaire, and proceeded to hand off the same 3 patients. Sessions were video-reviewed and hand offs scored for quality measures: word accuracy, errors of omission or commission, and appropriateness of clinical judgment. Quality measures among delivery methods and changes over time were compared.
  
  
  RESULTS
  Sixty-eight General Surgery residents (postgraduate year [PGY] 1-2) participated in at least 2 testing sessions, with 13 participating in 4. The IP method was superior to VB and SB for most hand off quality measures (each p < 0.001). With repeated testing, hand off quality measures improved (p < 0.001). However, patient hand offs continued to remain non-optimal, with appropriate judgment present in only 47%-77% of the hand offs. Sleep hours (mean 5 ± 2) were not found to be associated with hand off quality measures (p > 0.05). Most trainees preferred the IP method (73% vs 5% VB, 15% SB, 7% other; p < 0.001).
  
  
  CONCLUSIONS
  There is a need to provide formal training in hand off quality early in residency training. General surgery trainees clearly prefer and performed better, though not perfect, hand offs with the in-person method.
authors: Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: Benjamin
authors: B
authors: Zendejas
authors: Shahzad M
authors: SM
authors: Ali
authors: Marianne
authors: M
authors: Huebner
authors: David R
authors: DR
authors: Farley
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D019300:Medical Errors