Implementing a Comprehensive Handoff Program to Improve Pediatric Patient Safety

The investigators propose to test the hypothesis that implementation of a comprehensive handoff program (CHP) - i.e., implementation of a computerized handoff tool along with teamwork training for pediatric residents on inpatient units at Children's Hospital Boston - will lead to reductions in resident miscommunications / medical errors and improvements in workflow and experience on the wards.

Study Overview

• Status: Completed
• Conditions: Patient Safety; Resident Workflow; Resident Experience
• Intervention / Treatment: Other: Computerized handoff tool; Other: Team training

Detailed Description

Following collection of baseline data on two inpatient pediatric wards, teamwork training is to be provided to all pediatric residents. On our primary intervention unit, this will be accompanied by the introduction of a new computerized handoff tool that facilitates accurate transmission of data. The effects of this combined intervention on safety and workflow will be assessed on the primary intervention ward as compared with the historical control unit and the concurrent unit that received teamwork training without the computerized tool.

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Children's Hospital Boston

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• all residents working on study units during study period, except as below

Exclusion Criteria:

• residents on the teamwork only unit who have previously been on the primary intervention unit

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Computerized Handoff Tool plus training; Computerized handoff tool implemented together with team training for residents	Other: Computerized handoff tool; Informatics tool to aid in transfer of patient care information; Other: Team training; Teamwork training and revisions of handoff structure to optimize teamwork skills and verbal communications
Active Comparator: Team training only; No computerized tool	Other: Team training; Teamwork training and revisions of handoff structure to optimize teamwork skills and verbal communications

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rates of resident-related communication and total medical errors	Resident-related medical errors (including medication-related, diagnostic, and procedural) detected using a multi-pronged prospective surveillance methodology that involves 5d/week chart review, review of hospital incident reports, and collection of staff reports. Resident-related defined as involving a resident research subject. Communication errors are those medical errors attributable to communication failures.	July 2010

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rates of total medical errors	As above, but includes both those errors involving residents and those involving all other clinical personnel.	July 2010
Minutes residents spend updating the signout; minutes spent in direct patient care; minutes spent working at computer		July 2010
Resident reported experience of care	Self-reported, Likert scales on survey instruments.	July 2010
Rates of verbal miscommunications	Detected by direct observation, audio recording, then rating using study instrument developed for this purpose.	July 2010
Rates of written miscommunications	Detected by detailed review of written signouts, rated using study instrument developed for this purpose.	July 2010

Collaborators and Investigators

• Sponsor: Boston Children's Hospital
• Collaborators: Harvard Risk Management Foundation
• Investigators: Principal Investigator: Christopher P Landrigan, MD, MPH, Boston Children's Hospital

Study record dates

Study Major Dates

• Study Start: July 1, 2009
• Primary Completion (Actual): January 1, 2010
• Study Completion (Actual): January 1, 2010

Study Registration Dates

• First Submitted: May 25, 2010
• First Submitted That Met QC Criteria: June 1, 2010
• First Posted (Estimate): June 2, 2010

Study Record Updates

• Last Update Posted (Estimate): May 16, 2013
• Last Update Submitted That Met QC Criteria: May 15, 2013
• Last Verified: May 1, 2013

More Information

Terms related to this study

• Keywords: Patient Safety; Medical Errors; Resident; Handoff; Sign-out; Intern; Graduate Medical Education
• Other Study ID Numbers: X09-01-0040