Judging handoffs: Video study validates tool
Now you can tell if you’re doing it right
A short study in the July issue of the Journal of Hospital Medicine1 may change handoffs forever. For the first time, a tool created to judge the quality of how one physician passes the baton to another has been validated as effective.
Author Vineet Arora, MD, a hospitalist and associate professor of medicine at the University of Chicago Hospital, notes that there have been other tools used to judge handoffs, but this one — a mini-clinical examination exercise (CEX) — has been written about in the literature before, including by Arora and her colleagues.2 Some have created their own evaluation tools, too. But by taking one that was already out there and evaluating its validity, she says, Arora and her co-authors hoped to be able to someday create training materials that could be relied upon to deliver a particular set of skills.
A grant from the Agency for Healthcare Research and Quality (AHRQ) five years ago helped them to create this specific tool, which borrowed from best practices already in the literature. In 2011, they tested it. What was just published was an effort to ensure it was an objective measure. They filmed handoffs of various quality and showed them in random order to faculty from Yale and the University of Chicago. For the most part, the tool worked, and was able to help faculty draw valid conclusions about the quality of the handoffs they witnessed.
Now that they know this mini-CEX works, should it be used by everyone all the time? It is currently in use in a slightly different format at the University of Chicago hospital for hospitalists and residents. It is being tested as-is in different environments, such as the pediatric intensive care unit.
Given that there is a mandate by The Joint Commission and other groups to have a standard approach to handoffs, it seems like a good idea to be able to validate that what you do is hitting the mark, she says. "You can have a handoff standard, but if you aren’t measuring in some way, how do you know where you need to get better?"
Doing the observation work and rating, however, is very labor intensive. Someone in an organization will have to decide how often this kind of information should be collected, but Arora agrees that it should be done. "You can’t do every handoff every day," she says. "But you can do spot checks. That’s how I imagine it will be going forward. For a few days or a week, each unit will see how it is going."
She says there is some level of pushback from some physicians. But she notes that there is science you can show to those who do not like the idea of objective rating. "Those who self-rate are much more likely to rate themselves as better than they really are. That’s why we need to train people on what a satisfactory handoff looks like, or a superior one looks like."
Having videos of them to show as a training exercise will help ensure that people provide valid ratings, regardless of whether you use the mini-CEX tool she used or something else. "They give you a much better idea of the good, the bad, and the ugly."
- Arora VM, Berhie S, Horwitz LI, et al. Using standardized videos to validate a measure of handoff quality: The handoff mini-clinical examination exercise. J Hosp Med. 2014 Jul;9(7):441-6. Doi: 10.1002/jhm.2185.
- Horwitz LI, Rand D, Staisiunas P, et al. Development of a handoff evaluation tool for shift-to-shift physician handoffs: the Handoff CEX. J Hosp Med. 2013 Apr;8(4):191-200.
For more information on this topic, contact Vineet Arora, MD, Associate Professor of Medicine and Assistant Dean, Scholarship and Discovery, University of Chicago Hospital, Chicago, IL. Email: [email protected].
