Strategies and Tools to Enhance
Communication Among Health
Care Providers
BONNIE C. DESSELLE, MD
PROGRAM DIRECTOR
LSUHSC PEDIATRIC RESIDENCY PROGRAM
Communication Series
 Part 1: Hand – offs
 Part 2: Formal Presentations
 Part 3: Communication during Emergencies
Hand - Offs
 Mechanism of transferring information, responsibility
and/or authority from one set of care-givers to another
Sentinel Events
Root Causes of Sentinel Events
(1995-2005) -The Joint Commission of Accreditation of Hospitals
Communication
Orientation/training
Patient assessment
Staffing
Availabilty of info
Competency/credentialing
Procedural compliance
Environ. Safety/security
Leadership
Continuum of care
Care planning
Organization culture
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10
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Call to Improve Handoffs
 Joint Commission, 2006
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National Patient Safety Goal
 World Health Organization, 2006
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Prevention of handover errors part of “High Fives” patient safety
solutions
 Institute of Medicine, 2008
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Teaching programs “should train residents in how to hand over their
patients using effective communication.”
 ACGME, 2010
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Programs must ensure and monitor effective, structured hand-over
processes
Must ensure that residents are competent in the hand-over process
Group Discussion
Characteristics of
Worst and Best
Sign-offs
Group Discussion
Live demonstrations of sign-offs
Essential Elements for Pediatric Sign-out List
 Demographics
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Name
MRN
Unit/room number
Age
Weight
Gender
Allergies
Admit date
 Attending physician/Service/Consults
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Phone numbers and covering physician
 History and Problem List
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Primary diagnosis(es)
Chronic problems (pertinent to this admission/shift)
 Current condition/status
Essential Elements for Pediatric Sign-out List
 System based
 Pertinent Medications and Treatments
Oral and IV medications
 IV fluids
 Blood products
 Oxygen
 Respiratory therapy interventions
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 Pertinent lab data
 To do list
 Check x-ray, labs, wean treatments
 Include rationale
Essential Elements for Pediatric Sign-out List
 Contingency Planning
 What may go wrong and what to do
If this…then do this
 Include rationale
 What has/ has not worked before (e.g. responds to nasal
suctioning)
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 Code status/family situations
 Difficult family or psychosocial situations
 Code status, especially recent changes or family discussions
Practice a sign out
Essential Elements for Receiver
 Readback/Summation: co-orientation
 Questions/clarifications
 Collaborative cross check
Other Essential Elements
 Proper Environment: sterile cockpit
 No distractions
 Quiet place
 Always face to face
 Start with sickest patient
 Never say “ This is not my patient….I am just
covering for the night”
PGY- 1
 Essential Elements of Sign-out Giver Mastery
 Patient identification
 Patient background
 Current conditions or current physical exam
 Contingency plans
 Overall general treatment plan
PGY-2
 3 Essential Elements for Sign-out Receiver
Mastery
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Readback/summation: Co-orientation
Questions/clarifications
Solicit other overnight tasks for patient
PGY-3
 Has mastered giving and receiving sign-out
 Working towards:
 Collaborative cross check
 Off topic discussion that include teaching points
Summary
 Effective exchange of information is vital during
sign-outs
 Both the giver and receiver have specific roles and
responsibilities
 Hopefully we have given you some tools to make
your hand-offs more effective
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