title: Assessment and standardization of resident handoff practices: PACT project.
abstract: BACKGROUND
  Accreditation Council for Graduate Medical Education duty hour guidelines have resulted in increased patient care transfers. Although structured hand-over processes are required in the guidelines, how to implement these processes is not defined. The purpose of this study is to investigate current handoff methods at our center in order to develop an effective structured handoff process.
  
  
  METHODS
  This is a prospective study conducted at two hospitals with large in-house patient censuses. Resident focus groups were used to define current practices and future directions. Based on this input, we developed a direct observation handoff analysis tool to study time spent in handoffs, content, quality, and number of interruptions.
  
  
  RESULTS
  Trained medical students observed 86 handoffs. Survey response rates among junior and senior residents were 63% and 54%, respectively. Average daily patient census was 36 ± 10 patients with an average handoff time of 12 ± 9 min. There were 1.5 ± 1.8 interruptions per handoff. The majority of handoffs were unstructured. Based on information they were given in the handoff, junior residents had a 58% rate of incompletion of the assigned tasks and 54% incidence of being unable to answer a key patient status question.
  
  
  CONCLUSIONS
  Current handoffs are primarily unstructured, with significant deficits. Determination of key elements of an effective handoff coupled with evaluation of existing deficiencies in our program is essential in developing an institution-specific method for effective handoffs. We propose utilization of the mnemonic PACT (Priority, Admissions, Changes, Task) to standardize handoff communication.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. nmtapia@bcm.edu
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tapia
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.forename: Bradford G
authors.initials: BG
authors.lastname: Scott
authors.forename: James W
authors.initials: JW
authors.lastname: Suliburk
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000592:standards; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006742:Hospital Bed Capacity; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration* / Q000592:standards*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000592:standards; D011446:Prospective Studies; D013647:Task Performance and Analysis; D016526:Workload
keywords: Duty hours; Medical errors; Resident handoffs; Surgery