Transcript Strategies and Tools to Enchance Communication Among Health

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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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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