Posted: December 3, 2015

Handoff Interrupted: Auditory Distractions in a Standardized Handoff Simulation for Incoming Residents


This study addresses the efficacy of patient handoffs (EPA 8: "Give or receive a patient handover to transition care responsibility"). Entering PGY1 interns (N = 125) at the University of Chicago Medicine were required to complete a handoff simulation exercise as a part of their orientation program. Participating interns were instructed to verbally hand off a panel of three patients to trained receivers using a standardized written sign-out document. Interns were randomized to three simulation conditions: (1) an uninterrupted handoff, (2) a handoff with routine hospital noise (70-91 dB), or (3) a handoff with hospital noise and two pager interruptions sent to a trained receiver. Receivers evaluated participants using an evidence-based checklist of handoff best practices and a validated handoff mini-CEX instrument. While common hospital interruptions created non-ideal circumstances for effective communication, handoff performance was similar across all conditions. Interestingly, most interns were able to recover effectively from pages and avoid side conversations, and participants exposed to hospital noise used the written sign-out form more effectively. Handoff simulations incorporating elements of distraction were also well received by interns. This work provides novel evidence that handoff communication may not be affected by prevalent hospital interruptions as previously assumed. These findings underscore the importance of standardized templates in avoiding handoff errors and coping with challenges to effective clinical communication. The incorporation of auditory distractions into training exercises may also allow GME programs to comply more fully with CEPAER requirements-while also lending greater realism to standardized simulations. However, further research on the instruction and assessment of threats to handoff communication in a live hospital setting is needed.

*This poster was presented at the 2015 Medical Education Meeting CoreEPA Works in Process Poster Session.


Residency Programs, Simulations, Core Competencies, 2015 CoreEPA, Works in Process


Ellen Byrne, University of Chicago Harris School of Public Policy

Jeanne M. Farnan, MD, MHPE, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine

Kristen Hirsch, University of Chicago Graduate Medical Education

Lukas Matern, BA, University of Chicago Pritzker School of Medicine

Melissa Cappaert, MA, University of Chicago Medicine

Vineet M. Arora, MD, MAPP, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine