Implementation of a standardized electronic tool improves compliance, accuracy, and efficiency of trainee-to-trainee patient care handoffs after complex general surgical oncology procedures.
Duty-hour regulations have increased the frequency of trainee-trainee patient handoffs. Each handoff creates a potential source for communication errors that can lead to near-miss and patient-harm events. We investigated the utility, efficacy, and trainee experience associated with implementation of a novel, standardized, electronic handoff system.



We conducted a prospective intervention study of trainee-trainee handoffs of inpatients undergoing complex general surgical oncology procedures at a large tertiary institution. Preimplementation data were measured using trainee surveys and direct observation and by tracking delinquencies in charting. A standardized electronic handoff tool was created in a research electronic data capture (REDCap) database using the previously validated I-PASS methodology (illness severity, patient summary, action list, situational awareness and contingency planning, and synthesis). Electronic handoff was augmented by direct communication via phone or face-to-face interaction for inpatients deemed "watcher" or "unstable." Postimplementation handoff compliance, communication errors, and trainee work flow were measured and compared to preimplementation values using standard statistical analysis.



A total of 474 handoffs (203 preintervention and 271 postintervention) were observed over the study period; 86 handoffs involved patients admitted to the surgical intensive care unit, 344 patients admitted to the surgical stepdown unit, and 44 patients on the surgery ward. Implementation of the structured electronic tool resulted in an increase in trainee handoff compliance from 73% to 96% (P < .001) and decreased errors in communication by 50% (P = .044) while improving trainee efficiency and workflow.



A standardized electronic tool augmented by direct communication for higher acuity patients can improve compliance, accuracy, and efficiency of handoff communication between surgery trainees.
Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI.
Callisia N
CN
Clarke
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Sameer H
SH
Patel
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX; Department of Surgery, Programs in Arizona, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Phoenix, AZ.
Ryan W
RW
Day
Department of Clinical Operations Informatics, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Sobha
S
George
Department of Process Improvement and Quality Education, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Colin
C
Sweeney
Department of Process Improvement and Quality Education, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Georgina Avaloa
GA
Monetes De Oca
Department of Process Improvement and Quality Education, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Mohamed Ait
MA
Aiss
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Elizabeth G
EG
Grubbs
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Brian K
BK
Bednarski
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Jeffery E
JE
Lee
Department of Clinical Education, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Diane C
DC
Bodurka
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
John M
JM
Skibber
Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX. Electronic address: TAAloia@mdanderson.org.
Thomas A
TA
Aloia
D003142:Communication; D057286:Electronic Health Records; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D062209:Patient Handoff; D011446:Prospective Studies; D000071077:Surgical Oncology / Q000193:education*; D057188:Workflow