IMOUTA “is a great method for us,” said Dr. Brennan, whose department continues to use it. “Before, when I asked residents about patient details after patient handoffs, there was no standardized method or format for ensuring they knew exactly what needed to be done that night,” he said. “Clearly, things were missed.“
Explore This IssueSeptember 2013
“With the structured format being the same way every time, it helps with communication,” said Dr. Connor. “You become faster and more efficient at delivering the message, and on the receiving end, you know what the progression is going to be. You expect the information and you are better able to receive it.” The process also helped streamline communication.
Better Handoffs Moving Forward
Emphasizing the importance of the handoff can go a long way in making it better. “Enhanced teaching and oversight, including supervision of junior resident handoffs with senior residents,” can make them better, said Dr. Philibert. On the communication side, there’s been a relative lack of focus on the resident ‘receiving’ the handoff. “The role of the receiving resident is just as important. By asking the right questions, the receiving resident can contribute to a complete and accurate handoff,” she said. Dr. Philibert also said she’s been surprised by the emphasis on teaching the handoff as predominantly a communication and memory activity, rather than as a clinical task. For example, for a resident to communicate with accuracy about how likely it is that a patient may need extra attention over the next shift, the resident “needs to know the relative probabilities of different clinical events or complications occurring,” she said.
And knowing that is something that comes with experience. “A lot of times, the issues are minor and can be corrected, but there is a much smaller but still significant proportion of time when there are critical issues for the patient, resulting in major morbidity or death,” due to missed details during a handoff, said Dr. Abuzeid. “The actual gravity of the surgical handoff is something I probably didn’t appreciate until I did the research. My knowledge base as a second-year resident was such that I probably didn’t realize what I didn’t know until I completed my residency.”