Structured handoffs can improve the quality of patient information passed from one care team to another. This article describes intensivists' perspectives on a potential handoff tool (ICU-PAUSE) for handoff from the intensive care unit (ICU) to medical ward. They described the usefulness of a structured clinical note, especially regarding pending tests and the status of high-risk medications. Several barriers were also discussed, such as the frequent training required for residents who rotate in and out of the ICU and potential duplication of the daily chart note.

This mixed-methods study combined survey data from resident physicians with a comparison of process maps from three academic medical centers to assess handoffs from intensive care units to medical wards. The vast majority of survey respondents could recall at least one adverse event related to suboptimal handoff communication between these settings, and review of the process maps revealed safety gaps in existing processes.

Engaging trainees in quality improvement efforts has been an important area of focus within graduate medical education, but less is known about how health system resources are aligned with these activities. Researchers used survey data to better understand the perceptions of internal medicine residency program directors regarding health system support for and alignment with graduate medical education quality improvement efforts.

Training resident physicians to use structured handoff tools reduces errors in the care of hospitalized patients. Researchers developed a handoff simulation incorporating the types of noise and distractions that are ubiquitous in hospitals. After training, distracted residents provided the same quality handoff as those able to communicate in a quiet place.

… department visits after the care transition. A WebM&M commentary highlighted risks that breaches in continuity …

Research suggests that standardization, dedicated space, and supervision improve resident handoffs, but less is known about how these best practices are implemented. Investigators surveyed residency program directors and found significant variation in the implementation of recommended handoff practices and educational strategies.

This survey study examined remote electronic health record use by attending physicians for resident supervision. Nearly all respondents reported accessing the electronic health record remotely. Of these, 92% reported discovering clinically relevant information that the residents had not conveyed to them. The authors conclude that this "backstage" supervision requires further study to identify best practices for safety and education.

It is critical to educate trainees about patient safety. In this study, researchers described lessons learned from creating a leadership role that bridges quality and safety activities with graduate medical education in each of their institutions. Key responsibilities included clinical oversight, faculty development, and educational innovation. The authors advocate for further evaluation of this safety and education leadership role to determine its impact on medical education and patient outcomes.

Year-end handoffs in residency training settings are a known patient safety risk. This narrative review found that several practices can enhance the safety of year-end transitions, including standardizing written and verbal signout for high-risk patients and enhancing attending-level supervision.

This simulation study challenged medical students to identify patient safety hazards in a hospital room. Students demonstrated a wide range of accuracy in identifying hazards, with fall risk most likely and pressure ulcer risk least likely to be identified. This finding shows the utility of simulation in patient safety education.

Clinicians often feel pressured to work while sick or fatigued because of cultural and system factors, including fear of failing colleagues or patients. Exploring findings from a previous study on presenteeism, this commentary spotlights the need for health care organizations to discourage clinicians from working while ill which poses risks to patients. The authors recommend strategies and policies to address this problem, including promoting professionalism that conveys physicians must be healthy enough to provide patient care.

… by Dr. Debra Weinstein, the discussion featured Dr. Vineet Arora, Dr. Eileen Reynolds, and surgical resident Dr. Brian … of their overnight experiences. A recent AHRQ WebM&M perspective and interview also discussed the potential …

This commentary describes an elective program blending safety and quality improvement training into a medical school curriculum.

The academic year-end transfer of primary care patients from graduating residents to their successors can pose risks to patients. This survey of patients within an academic primary care practice identifies the concerns patients have with the transfer process and the barriers in care they encounter as a result.

Peer evaluation of resident handoffs revealed that interns improved both communication and listening skills over the course of an academic year.

Although much research on effective handoffs has emphasized the responsibility of the sender (the clinician transmitting information), this study evaluated the behavior of clinicians receiving handoffs and found that most clinicians did not engage in active listening behaviors that could improve the quality of information transmission.

Discussing how residents continue to work beyond duty hour limits, this commentary advocates for a new model of professionalism to help faculty and trainees view compliance with duty hours as a professional practice behavior.