Students learning handovers in a simulated in-patient unit
Debra L Klamen, Southern Illinois University School of Medicine, 801 North Rutledge, PO Box 19622, Springfield, Illinois 62794, USA. Tel: 00 1 217 545 7932; Fax: 00 1 217 545 0192; E-mail: firstname.lastname@example.org
Context and setting
The issue of patient safety is one of great importance. Formalised training in handovers (the transfer of role and responsibility from one person to another), however, is rare, and essentially non-existent for medical students. We designed a novel strategy for teaching handovers to Year 2 medical students.
Why the idea was necessary
According to estimates from the Institute of Medicine, up to 98 000 patients die in US hospitals annually as a result of errors. In 2005, a Joint Commission analysis found that 70% of sentinel events were caused by communication breakdowns, half of which occurred during handovers. In another study, 59% of residents reported that one or more patients had been harmed during one clinical rotation as a result of a problematic handover. Of these, 12% reported that the harm had been major. Clearly, the skills needed to hand over patient care are critical.
What was done
To provide background for the patient safety experience, students were given information about handovers and their impact on patient safety on their online curriculum site. This background included written information on how to perform a handover, including elements crucial to its success. Students were also provided with a video of a reference standard handover being performed. Students were then encouraged to practise a handover in their small tutorial groups.
The simulated inpatient unit consisted of eight rooms in a standardised patient suite. Each room held a recently admitted ‘patient’ with pancreatitis. Just outside each room was the simulated ‘nursing station’, a computer laboratory filled with nurses in scrubs, charts, beeping monitors, buzzing pagers and ringing telephones. Each student was required to:
- 1 see the patient;
- 2 write a subjective, objective, assessment, plan (SOAP) note about the patient;
- 3 receive laboratory test results while in the nurse’s station (a haemoglobin/haematocrit level, showing a precipitous drop, and a medical error consisting of a laboratory test for another patient, not the student’s own);
- 4 make a verbal handover to a ‘standardised resident’ and obtain feedback, and
- 5 attend a debriefing session to discuss the experience.
Evaluation of results and impact
Students did very well on learning the process of a handover, scoring an average of 81.5% on the 10-item checklist. They generally commented very positively on the experience and gave it a mean rating of 4.152 on a scale of 1 to 5. Thirty-eight of the 69 students made a medical error (i.e. they took the wrong laboratory data and incorporated them into their work without realising the lab test did not refer to their patient). Thirteen students caught the error and acted appropriately, returning the lab result to the nurse who had given it to them initially.
We conclude that the simulated in-patient unit was an effective and efficient environment in which to teach students about handovers in a busy, demanding in-patient unit setting. The fact that so many students made a medical error themselves further drove home the teaching points about why medical errors are so prevalent and why good handovers are so important.