Key Principles:

1. Maintain a structured hand off process
2. Ensure residents are aware and educated on the hand off process
3. The hand off will include patient diagnosis, prioritized treatment plan andto-do list
4. On–call schedule will be updated and easily accessible to all team members

Key Issues:

• Structured Hand Off
  • Minimize transitions of care
  • Maintain hand off between residents for inpatient care
  • Coordination of care from hospital setting to outpatient follow-up
  • Hand off (s) in form of Shared Patient List(s) created in electronic medical record (EMR), updated daily
  • Lists includes patient features such as name, age, location, MRN, diagnosis, treatment plan and tasks (prioritized)-Verbal review with incoming team twice daily
• Fellow/Faculty and other Trainee Education
  • Review of hand off process for new residents at orientation
  • Refresher of hand off process for upper level residents annually
  • Ensure EMR lists are kept updated, with urgent ‘To Do’ items highlighted and also verbally relayed
• Included Patient Details and Plan
  • For each patient on the team hand offs should include primary diagnosis,treatment, and urgent issues.
  • Plans after discharge should be clearly delineated in hand off and in the notes
• Availability of Schedule and Back-Up
  • On call schedule (daily) for residents and faculty available at all times
  • Plan for back-up if needed
• Continuous Assessment and Improvement
  • Obtain feedback on process regularly (at least at annual program evaluation)
  • If needed, present issues at patient safety conferences
  • If needed, residents bring issues to program director’s attention and action taken ASAP
  • Performance of quality improvement projects by residents to improve hand offs