Multicenter development, implementation, and patient safety impacts of a simulation-based module to teach handovers to pediatric residents.
OBJECTIVE
Teaching and evaluation of handovers are important requirements of graduate medical education (GME), but well-defined and effective methods have not been clearly established. Case-based computer simulations provide potential methods to teach, evaluate, and practice handovers.


METHODS
Case-based computer simulation modules were developed. In these modules, trainees care for a virtual patient in a time-lapsed session, followed by real-time synthesis and handover of the clinical information to a partner who uses this information to continue caring for the same patient in a simulated night scenario, with an observer tallying included handover components. The process culminates with evaluator feedback and structured handover education. Surveys were used before and after module implementation to allow the interns to rate the quality of handover provided and record rapid responses and transfers to the ICU.


RESULTS
Fifty-two pediatric and medicine/pediatric residents from 2 institutions participated in the modules. "Anticipatory guidance" elements of the handover were the most frequently excluded (missing at least 1 component in 77% of module handovers). There were no significant differences in the proportion of nights with rapid response calls (7.24% vs 12.79%, P=.052) or transfers to the ICU (7.76% vs 11.27%, P=.21) before and after module implementation.


CONCLUSIONS
Case-based, computer-simulation modules are an easily implemented and generalizable mechanism for handover education and assessment. Although significant improvements in patient safety outcomes were not seen as a result of the educational module alone, novel techniques of this nature may supplement handover bundles that have been demonstrated to improve patient safety.
Department of Pediatrics, Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; and david.p.johnson.1@vanderbilt.edu.
David P
DP
Johnson
Department of Pediatrics, and Division of Pediatric Critical Care, Duke Children's Hospital, Durham, North Carolina.
Kanecia
K
Zimmerman
Department of Pediatrics, and.
Betty
B
Staples
Department of Pediatrics, and.
Kathleen A
KA
McGann
Department of Pediatrics, and.
Karen
K
Frush
Department of Pediatrics, and Division of Pediatric Critical Care, Duke Children's Hospital, Durham, North Carolina.
David A
DA
Turner
D003198:Computer Simulation; D003266:Continuity of Patient Care; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D062209:Patient Handoff / Q000592:standards*; D061214:Patient Safety; D010372:Pediatrics / Q000193:education*; D016730:Program Development; D058996:Quality Improvement; D013663:Teaching; D014481:United States
computer simulation; handovers; patient safety; resident education; sign-outs; transition of care