Because communication and handoff failures are a root cause of two-thirds of "sentinel events"– serious, often fatal preventable adverse events in hospitals – improving handoffs has been identified by AHRQ and the Joint Commission as a priority in nationwide efforts to improve patient safety. Comparative Effectiveness Research on handoff tools and processes has identified specific strategies to improve handoffs and reduce medical errors:
To accelerate residents' use of CER-based handoff practices and improve patient safety, we are implementing the three inventions above as a Resident Handoff Bundle (RHB) in eight pediatric hospitals in the United States and Canada.
The Department of Health and Human Services has funded $3 million for this 3-year project.
The project website (ipasshandoffstudy.com) is currently under development.
Resident Sign-Out Practices: Results from a Multu-Site Needs Assessment
Amy J. Starmer, MD, MPH, Children's Hospital Boston, Boston, MA, Nancy Spector, MD, St. Christopher's Hospital For Children, Philadelphia, PA, Christopher P. Landrigan, MD, MPH, Theodore Sectish, MD, Children's Hospital Boston, Boston, MA, Maitreya Coffey, MD, Hospital for Sick Children, Toronto, Ontario, Canada, F. S. Cole, MD, Washington University in St. Louis, St. Louis, MO, Jennifer Hepps, MD, National Capital Consortium, Bethesda, MD, Madelyn Kahana, MD, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, Jennifer O'Toole, MD, Cincinnati Children's Medical Center, Cincinnati, OH, Glen Rosenbluth, MD, University of California, San Francisco, San Francisco, CA, Adam Stevenson, MD, James F. Bale, MD, University of Utah, Salt Lake City, UT
Impact of a Resident Handoff Bundle on Resident Workflow Patterns and Verbal Handoff Practices
Amy J. Starmer, Theodore Sectish, Dennis Simon, Christopher P. Landrigan. PAS #1 (May 3, 2011) Impact of a Resident Handoff Bundle on Medical Error Rates and Written Handoff Miscommunications. Amy J. Starmer, Theodore Sectish, Dennis Simon, Christopher P. Landrigan.
Impact of a Resident Handoff Bundle on Medical Error Rates and Written Handoff Miscommunications. Amy J. Starmer, Theodore Sectish, Dennis Simon, Christopher P. Landrigan