Standardizing the culture of trauma rotation handoffs.
OBJECTIVE
One of the General Surgery milestones focuses on effective handoffs between residents as they change shifts. Although the content of handoffs is crucial, we recognized that the culture of handoffs was equally important. After the reorganization of the trauma service at our institution, there were difficulties in maintaining the standardized handoff culture. We analyzed the culture of handoffs on the trauma service to create an environment more conducive to effective handoffs.


METHODS
All trauma activations from 2012 to 2013 were evaluated from our institution's trauma data registry. Data on timing of activations and disposition of the patient were analyzed to understand service work flow. A survey was developed and administered to the residents to assess the culture of trauma handoffs.


METHODS
This work occurred at an academic, state-designated level 1 trauma center.


METHODS
All current residents in the general surgery residency who rotated on the trauma service in the last 5 years.


RESULTS
There were 1654 admissions to the trauma service from June 2012 to July 2013. The single busiest hour for trauma admissions (7% of admissions) was the same time the residents were designated to handoff. Interruptions occurred often; 83% of residents indicated that a handoff interruption occurred daily, and 73% indicated a new activation interrupted handoffs weekly. A large majority, 61%, felt patient care was frequently compromised by an ineffective handoff. Similarly, as a direct result of inadequate handoffs, 50% felt uncomfortable answering nurses' pages at night.


CONCLUSIONS
The unique situation of the trauma service impaired the handoff culture for residents. Assessment of our trauma activation flow indicates the timing of handoffs was adversely affecting our resident's ability to handoff effectively, requiring interventions to improve the efficacy and safety of handoffs.
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Cathleen
C
Khandelwal
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Jason
J
Mizell
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Matthew
M
Steliga
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: KSBerry@uams.edu.
Katherine
K
Berry
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Mary Katherine
MK
Kimbrough
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Frederick
F
Bentley
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
James
J
Clardy
D006801:Humans; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care; D005791:Patient Care; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards*; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000601:surgery*
Interpersonal and Communication Skills; Medical Knowledge; Patient Care; milestones; transitions of care; trauma surgery education