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.

… journal of the American College of Medical Quality … Am J Med Qual … Engaging trainees in 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.

When resident physicians leave their primary care clinic at graduation, their patients are vulnerable to adverse events. This internal medicine residency program created an enhanced handoff system that improved continuity, increased appropriate test follow-up, and demonstrated a trend toward reduced hospital and emergency department visits after the care transition. A WebM&M commentary highlighted risks that breaches in continuity pose to outpatients.

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.

… Journal of graduate medical education … J Grad Med Educ … This survey study examined remote …

… Journal of graduate medical education … J Grad Med Educ … It is critical to educate trainees about …

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … Year-end handoffs in residency training …

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 …

… journal of the American College of Medical Quality … Am J Med Qual … This commentary describes an elective program …

… Journal of general internal medicine … J Gen Intern Med … The academic year-end transfer of primary …

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.

Conducted before implementation of the 2011 ACGME duty hour limits, this survey found that the majority of internal medicine and surgery program directors believed the new regulations would negatively affect the learning environment and continuity of care, as well as result in increased faculty workload and require changes in clinical services.

This commentary describes a template to standardize handoff education to drive safety improvement.