Journal de médecine générale

Implementing an Institutional Objective Simulated Handoff Evaluation (OSHE) for Assessing Resident Handoff Skill

Abstract

Tsveti Markova, Lisa Dillon and James Coticchia

Introduction: In order to properly educate residents about the communication components involved in effective handoff delivery, interventions that promote demonstration of skill with real-time feedback are essential. Our institution developed a focused intervention for all residency programs to improve handoff education by implementing standardized written and verbal templates throughout all specialties. We decided upon a common framework for education and evaluation of resident handoff competency: the objective simulated handoff evaluation (OSHE) originally developed by Farnan et al. Handoffs are critically important for patient quality of care and safety. Methods:Residents completed the objective simulated handoff evaluation in pairs where the junior resident completed a verbal and written hand off using a simulated case to a senior resident in the same specialty. The senior residents provided feedback on the verbal handoff and faculty scored the written templates. The junior residents were surveyed pre-and-post to assess resident handoff education prior to the exercise and to gather feedback. Results: Residents rated their ability to pick up a new service significantly higher after the objective simulated handoff evaluation, (Mdn=4), U=308, p=0.005, r=0.34, in contrast to their initial rating (Mdn=3). Additionally, residents reported higher confidence in making contingency plans, (Mdn=4), U=311, p=0.005, r=0.35, compared to baseline (Mdn=3). Performing a read back showed improvement, (Mdn=4), U=321, p=0.01, r=0.31, when compared to the pre-survey (Mdn=3). Finally, when to perform a read-back also improved post-objective simulated handoff evaluation, (Mdn=4), U=323, p=0.01, r=0.32, when compared to the baseline (Mdn=3). Conclusion: Our institution-wide focus on standardization demonstrated that residency programs can collaborate productively despite their specialty-specific differences in transfers of care. Handoff education is essential in positively affecting patient care.