Hand Offs

Dear Ryan Handling hand-offs: a national survey of program directors on standardized hand-offs in emergency medicine training Coughlin R, Goldflam K, Bradby C, Nwoke F, Srica N, Jameyfield E, Della-Giustina D and Tsyrulnik A Abstract Background: Structured hand-offs in Emergency Medicine (EM) are known to improve patient care, and several prior studies have proposed specific processes. However, little is known regarding current implementation and education of trainees on structured hand-offs in EM residency programs. Methods: We surveyed EM program directors (PDs) using a mixed-methods approach to explore the current use of and education regarding structured hand-offs in residency programs. Descriptive data were reported as percentages. An adjunct analysis of free-text responses was done using the framework method. Results: A total of 174 PD responses were collected for a response rate of 63%. Of those, 69% (119/172) currently use a structured hand-off, though among those who answered the frequency question (n=103), only about half (51%) report its use as "very often," suggesting consistent use in roughly one-third of all programs. Of the 154 respondents who answered the education question, 95% reported providing some form of hand-off instruction, while 29% teach general sign-out procedures without presenting a specific structured format and 5% reported no curriculum coverage. Thirty-four percent (53/154) reported at least one safety event attributed to poor hand-off practices. Qualitative analysis revealed that PDs whose programs use a structured hand-off appreciate the clarity and efficiency it provides and feel it improves patient safety and trainee education. However, poor tool design, lack of physician commitment, and finite resources were cited as negative aspects of using a structured hand-off tool as well as reasons for its use being abandoned by some programs. Conclusions Most EM programs currently implement a structured hand-off and provide their residents with training on general sign-out procedures, with some teaching specific structured processes. While benefits of such processes are recognized, logistical hurdles and inconsistent application prevent more widespread sustained use.