New ACGME Requirements for Handoffs:
Guidelines for AADPRT Members
Effective July 1, 2011, residency training programs will need to comply with new ACMGE requirements for
handoffs

Programs must design clinical assignments to minimize the number of transitions in patient care.

Sponsoring institutions and programs must ensure and monitor effective, structured hand-over
processes that 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.

The sponsoring institution must ensure the availability of schedules that inform all members of the
health care team of attending physicians and residents currently responsible for each patient's care.
As each training program implements these new requirements, we recommend the following principles:
1. Train residents in close collaboration with clinical service/system in safe and effective handoffs. It
is important to synchronize this training with the processes that will be used by the service.
2. Assess competence with giving AND receiving sign-out. Chart audit of written transfer summaries,
direct observation with structured feedback and multi-source feedback are three excellent
approaches to this.
3. Standardize both written and verbal sign-out; link to EMR when possible.
4. Adapt process (e.g., whether verbal sign-out required on all patients) and information
requirements to the specific type of handoff (e.g., outpatient vs. inpatient, permanent change in
clinician vs. covering during leave/vacation).
5. Primary responsibility lies with each clinical service and the licensed system in which it exists.
The 'best practice' models of handoffs include the following elements:
1. Structured verbal (including face-to-face) sign-out with interactive questioning in a quiet setting
free of interruptions. Multiple structured formats have been developed for verbal sign-out. The key
is that the clinical services/systems choose an approach and train clinicians accordingly.
2. Written sign-out supported by computer-based, standardized templates that prompt for handoff
relevant information and ideally are linked to the EMR1 to reduce redundant data entry (and
errors);
3. Identification of acute or higher risk patients for enhanced sign-out/care;
4. Definitive transfer of professional responsibility at a specific time.
Source: http://www.aadprt.org/pages.aspx?PanelID=0&PageName=ACGME_Requirements_for_Handoffs
2011 ACGME Common Program Requirements:
Handoffs


Joint Commission: National Patient Safety Goal,
Handoffs
Programs must design clinical assignments to
minimize the number of transitions in patient
care.

Sponsoring institutions and programs must
ensure and monitor effective, structured
hand-over processes that facilitate both
continuity of care and patient safety.
Implement a standardized approach to
"handoff" communications including an
opportunity to ask and respond to questions

Expectations:

Programs must ensure that residents are
competent in communicating with team
members in the hand-over process.

The sponsoring institution must ensure the
availability of schedules that inform all
members of the health care team of attending
physicians and residents currently
responsible for each patient's care.
o
Interactive communications:
opportunity for questions
o
Minimum content: Up-to-date
information
o
Interruptions are limited
o
Process for verification: "read-back"
o
Opportunity to review prior care
o
Allocation of schedule for handoffs
Best Practices for Handoffs
Content

Key demographic
information

Contact information
for other members of
treatment team

Summary of diagnoses,
clinical status, and
treatment plan

Active issues (e.g.,
pending titration,
recent relapse, new
stressor)

Assessment of acuity

Tasks to be done

Anticipatory guidance

(if-then statements)
Infrastructure


Easily accessible
information
technology (e.g,
printers,
computers,
phones)
Structured
written electronic
template prepopulated with
information from
EMR when
possible

Quiet setting for
handoffs

Overlapping
shifts or
protected time for
handoffs
Communication Process

Structured
written and
verbal (often
ideally face-toface) sign-out
that use
same/complimen
tary format

Opportunity for
interactive
questioning,
read-backs,
review of
anticipated
problems

Minimal
interruptions

Prepare the
patient as well!
Organization

Adopt
standardized
approach to
handoffs

Train clinicians
in handoffs
communication

Assess
competence with
giving and
receiving
handoffs
Types of Handoffs
Permanent
Cover/Hold
Actively
manage care

End of Rotation (outpatient
and intensive services)

Patient transferred from other
service/level of care
Temporary

Nights/Weekend (outpatient)

Vacation/Other Leave (outpatient)

Nights/Weekend (intensive services)

Nights/Weekend (intensive services)

Vacation/Other Leave (intensive services or
extended outpatient leave)
Handoff Triggers
Patient factors
Clinician factors

Change in level of care (outpatient to inpatient)

Change in intensity of care (e.g., add psychotherapy to med mgmt)

End of shift

Vacation/Other Leave

End of Rotation or graduation
References
1. UHC best practice recommendation: patient communication white paper: University Health
System Consortium;May 2006.
2. Vidyarthi AR, Arora V, Schnipper JL, Wall SD, Wachter RM. Managing discontinuity in academic
medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. Jul
2006;1(4):257-266.
3. Improving Handoff Communications: Meeting National Patient Safety Goal 2E. Joint Commission
Perspectives on Patient Safety. 2006;6:9-15.
4. Ulmer C, Wolman DM, Johns MME, Institute of Medicine (U.S.). Committee on Optimizing
Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety.
Resident duty hours : enhancing sleep, supervision, and safety. Washington, DC: National
Academies Press; 2009.
5. Accreditation Council of Graduate Medical Education. ACGME Duty Hours.
http://www.acgme.org/acWebsite/dutyHours/dh_index.asp. Accessed February 6, 2011.
6. Joint Commission. National Patient Safety Goals. www.jointcommission.org, November 13, 2008.
7. Department of Defense, Agency for Healthcare Research and Quality. TeamSTEPPSTM: Strategies
and Tools to Enhance Performance and Patient Safety: Guide to Action. 2006.