The Otorhinolaryngology Hand-Off:
Pursuing Excellence in Patient Care
and Safety
Mark A. Zacharek, MD, FACS, FAAOA
Associate Professor
Associate Residency Program Director
Department of Otorhinolaryngology
Michigan Sinus Center
University of Michigan Health System
ACGME Common Program
Requirements
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“Sponsoring institutions must ensure and
monitor effective, structured hand-over
processes to facilitate both continuity of
care and patient safety. Programs must
ensure that residents are competent in
communicating with team members in the
hand-over process.”
ACGME 2011 CPR
www.acgme.org
Halstead on Surgical Residency
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“It will be objected that this is too
long an apprenticeship, that the
young surgeon will be stale, his
enthusiasm gone before he has
completed his arduous term of
service. These positions are not
for those who soon weary of the
study of their profession, and it is
a fact that the zeal and industry of
these young assistants seem to
increase as they advance in years
and as their knowledge and
responsibilities become greater.”
The Otorhinolaryngology Hand-off
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ACGME standards promote teamwork.
“Residents must work effectively as a member or
leader of a health care team or other professional
group.”
“Residents are expected to work in interprofessional teams to enhance patient safety and
improve patient care quality.”
“Residents should have representation on hospital
quality improvement committees.”
ACGME 2011 CPR www.acgme.org
Residents have Duty Hour
Restrictions
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With a focus on restricted duty hours, the
importance of communication between
teams and individuals is of the utmost
importance.
Bo Schembechler (1983)“The Team, The Team, The Team!”
The “handoff” (“handover” “signout” ) is
part of the continuity of care when one
resident is no longer in the hospital for a
continuous period of time.
Definition: Transitions of Care
ACGME 2011 CPR
www.acgme.org
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Programs must design clinical assignments to
minimize the number of transitions in patient care.
Responsibility for each patient may be transferred
between 2 or more residents within a 24 hour
period.
“Sponsoring institutions and programs must ensure
and monitor effective, structured handover
processes to facilitate both continuity of care and
patient safety. Programs must ensure that residents
are competent in communicating with team
members in the handover process.”
Can we standardize the
otorhinolaryngology “handoff”?
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Handoffs may occur asynchronously without
person to person/face to face interaction.
Reduction in errors due to fatigue should
not be offset by an increase in errors due to
poor communication/improper information
transfer.
Multiple types of Handoffs
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Post-op Ambulatory
Inpatient consult
Outpatient/clinic
Primary Oto inpatient service
Primary Oto SICU patient in closed ICU
system (General Surgery Staff and Resident)
Different Otolaryngology Services
(Neurotology, Head and Neck, VA, Pediatric)
Multiple Hospitals (Home Call vs In House)
Program Director Strategies:
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Supervision and provision of feedback
Coaching (Senior resident and faculty
observation of junior handoffs)
Objective skills-based examinations
Simulation of practice handoff skills
Metrics in Portfolio for “Interpersonal
Skills and Communication”
Using a checklist?
What do other professionals do?
Causes of Error in Teaching
Hospitals
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Between 1979-2001, closed malpractice
claims data
240 errors in teaching settings
- errors in judgement 72%
- problems with teamwork 70%
- lack of technical competence 58%
Singh H et al. Medical errors involving trainees: a study of
Closed malpractice claims for 5 insurers. Arch Intern Med.
2007;167(19):2030-2036
Transitions of Care in the Training
Environment: ACGME Standards
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Dr. Bradley Marple, MD Dr. Marple
is Professor and Vice Chairman of the
Department of OtorhinolaryngologyHead and Neck Surgery at the
University of Texas Southwestern.
Additionally, he is the Chair of
the ACGME Otolaryngology Residency
Review Committee.
Patient Handoffs: A Cognitive
Systems Engineering Perspective
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Emily Patterson, PhD Dr. Patterson is an
assistant professor at Ohio State University
in the Health Information Management and
Systems Division of the School of Allied
Medical Professionals in the College of
Medicine. She is an expert in the field of
cognitive systems engineering with interests
in health informatics and macro-cognitive
communication.
Patient Hand-offs: A Medical
Education Perspective
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Ingrid Philibert, PhD MBA Senior Vice
President, Department of Field Activities at
the ACGME. Dr. Philibert is responsible for
the Council's 31 MD and PhD accreditation
field representatives as well as the 2000 site
visits conducted annually. She is one of the
editors of the ACGME's recent monologue
regarding Duty Hour Standards "The ACGME
2011 Duty Hour Standards: Enhancing
Quality of Care, Supervision, and Resident
Professional Development".
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