Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery

Objective: To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. Design: Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. Setting: Large teaching hospital. Participants: Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). Intervention: A handoff tool for use by orthopaedic residents. Main Outcome Measurements: Adverse events in patients handed off by orthopaedic trauma residents. Results: After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). Conclusions: Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients.