Patient Safety, Resident Experience, Resident Workflow
Conditions
Keywords
Patient Safety, Medical Errors, Handoff, Sign-out, Resident, Intern, Graduate Medical Education
Brief summary
The investigators propose to test the hypothesis that implementation of a comprehensive handoff program (CHP) - i.e., implementation of a computerized handoff tool along with teamwork training for pediatric residents on inpatient units at Children's Hospital Boston - will lead to reductions in resident miscommunications / medical errors and improvements in workflow and experience on the wards.
Detailed description
Following collection of baseline data on two inpatient pediatric wards, teamwork training is to be provided to all pediatric residents. On our primary intervention unit, this will be accompanied by the introduction of a new computerized handoff tool that facilitates accurate transmission of data. The effects of this combined intervention on safety and workflow will be assessed on the primary intervention ward as compared with the historical control unit and the concurrent unit that received teamwork training without the computerized tool.
Interventions
Informatics tool to aid in transfer of patient care information
OTHERTeam training
Teamwork training and revisions of handoff structure to optimize teamwork skills and verbal communications
Sponsors
Harvard Risk Management Foundation
Boston Children's Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* all residents working on study units during study period, except as below
Exclusion criteria
* residents on the teamwork only unit who have previously been on the primary intervention unit
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rates of resident-related communication and total medical errors | July 2010 | Resident-related medical errors (including medication-related, diagnostic, and procedural) detected using a multi-pronged prospective surveillance methodology that involves 5d/week chart review, review of hospital incident reports, and collection of staff reports. Resident-related defined as involving a resident research subject. Communication errors are those medical errors attributable to communication failures. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rates of total medical errors | July 2010 | As above, but includes both those errors involving residents and those involving all other clinical personnel. |
| Minutes residents spend updating the signout; minutes spent in direct patient care; minutes spent working at computer | July 2010 | — |
| Resident reported experience of care | July 2010 | Self-reported, Likert scales on survey instruments. |
| Rates of verbal miscommunications | July 2010 | Detected by direct observation, audio recording, then rating using study instrument developed for this purpose. |
| Rates of written miscommunications | July 2010 | Detected by detailed review of written signouts, rated using study instrument developed for this purpose. |
Countries
United States
Outcome results
None listed