Implementing a Comprehensive Handoff Program to Improve Pediatric Patient Safety

• Rates of total medical errors [ Time Frame: July 2010 ] [ Designated as safety issue: Yes ]
  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 [ Time Frame: July 2010 ] [ Designated as safety issue: No ]
• Resident reported experience of care [ Time Frame: July 2010 ] [ Designated as safety issue: No ]
  Self-reported, Likert scales on survey instruments.
• Rates of verbal miscommunications [ Time Frame: July 2010 ] [ Designated as safety issue: Yes ]
  Detected by direct observation, audio recording, then rating using study instrument developed for this purpose.
• Rates of written miscommunications [ Time Frame: July 2010 ] [ Designated as safety issue: Yes ]
  Detected by detailed review of written signouts, rated using study instrument developed for this purpose.

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.

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.

• Patient Safety
• Resident Workflow
• Resident Experience

• Other: Computerized handoff tool
  Informatics tool to aid in transfer of patient care information
• Other: Team training
  Teamwork training and revisions of handoff structure to optimize teamwork skills and verbal communications

• Experimental: Computerized Handoff Tool plus training
  Computerized handoff tool implemented together with team training for residents
  Interventions:

  • Other: Computerized handoff tool
  • Other: Team training
• Active Comparator: Team training only
  No computerized tool
  Intervention: Other: Team training

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