title: Sustainability and effectiveness of a quality improvement project to improve handoffs to night float residents in an internal medicine residency program.
abstract: BACKGROUND
  Handoff is the process in which patient care is transitioned from one provider to another. In teaching hospitals, handoffs are frequent, and resident duty hour restrictions have increased the use of night float staff. To date, few studies have focused on long-term sustainability and effectiveness of a handoff quality improvement project.
  
  
  OBJECTIVE
  The objective of our resident-driven quality improvement project was to evaluate the effectiveness and sustainability of a standardized template for handoff quality in a community hospital internal medicine program.
  
  
  METHODS
  We used a multistep continuous quality improvement approach. Problems in the handoff process were identified through process mapping and anonymous needs assessment of the residents. A group of residents and faculty identified problems during biweekly discussions, created a standardized template, and adopted a new handoff process. We audited handoffs and surveyed residents at 3 and 9 months after implementation to assess effectiveness and sustainability.
  
  
  RESULTS
  Before the intervention, only 40% of residents reported regular morning handoff. Using the standardized template, statistically significant, sustained improvements were seen in morning handoff frequency (59% preintervention, 90% at 3 months, 89% at 9 months), along with decreases in unreported overnight events (84% preintervention, 58% at 3 months, 50% at 9 months) and uncertainty about decisions because of poor handoffs (72% preintervention, 49% at 3 months, 37% at 9 months). Statistically significant decreases in missed content (69%-46%) and copy-and-paste behavior (78%-38%) at 3 months were not sustained.
  
  
  CONCLUSIONS
  We demonstrated sustained improvements in unreported events and uncertainty caused by poor handoffs. Initial improvements in missed content and copy-and-paste behavior that were not sustained suggest a need for ongoing reinforcement and monitoring of handoff quality.
authors.forename: Cemal
authors.initials: C
authors.lastname: Yazici
authors.forename: Hany
authors.initials: H
authors.lastname: Abdelmalak
authors.forename: Shanu
authors.initials: S
authors.lastname: Gupta
authors.forename: Anna
authors.initials: A
authors.lastname: Shmagel
authors.forename: Eman
authors.initials: E
authors.lastname: Albaddawi
authors.forename: Vivian
authors.initials: V
authors.lastname: Tsang
authors.forename: Steven
authors.initials: S
authors.lastname: Potts
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora