PACT project: standardized resident handoff implementation improves handoff quality

QUALITY, OUTCOMES AND COSTS I The impact of promotional language on patient preference for innovative procedures Peter R Dixon, Robert C Grant, David R Urbach, MD, MS, FRCSC, FACS Toronto General Hospital Toronto, Ontario, Canada

effectiveness, junior-resident perceptions of communication, and senior-resident reporting of incomplete patient-care tasks and lack of patient knowledge on morning rounds were recorded using Likert-scale questionnaires. Statistical analysis included chi-square and Student’s t-test.

INTRODUCTION: While robotic-assisted surgery has become increasingly popular over the past decade, there is limited evidence supporting a benefit beyond less expensive conventional laparoscopic surgery. It is possible that marketing pressure is partly responsible for the widespread adoption of robotic-assisted surgery. In particular, physician-directed and direct-to-consumer advertising and promotion highlights robotic-assisted surgery using terms that emphasize its novelty, which are unrelated to statements about evidence. The impact of language on patient preference for innovative procedures has not been investigated.

RESULTS: We assessed 114 pre-intervention and 140 post-intervention intern-level handoffs. Discussion of PACT content increased significantly, as did the recommended order of discussion. Handoff time increased significantly, as did patient census. Despite increased census, incidence of incomplete tasks and lack of patient knowledge decreased, indicating improved handoff practices (Table). Discrepancy between junior and senior handoffs decreased (p<0.001), and senior residents reported junior residents were better able to handle emergencies (p¼0.03).

METHODS: We surveyed 38 persons at risk of colorectal cancer to elicit their preference of surgical technique for partial colectomy, presented with a hypothetical diagnosis of colon cancer. Each subject made two treatment decisions between robotic-assisted surgery and laparoscopic surgery, with robotic-assisted surgery described as “innovative” and “state-of-the-art” (marketing frame), as well as a second preference elicitation highlighting uncertainty of available evidence (evidence-based frame), in alternating order. RESULTS: 20 participants (52.6%, 95% CI 37.3-67.5) selected robotic-assisted surgery in the marketing frame, as compared with 9 (23.7%, 95% CI 13.0-39.2) in the evidence-based frame. The magnitude of the framing effect was large, with 12 of 20 (60.0%, 95% CI 38.7-78.1) who selected robotic-assisted surgery in the marketing frame selecting laparoscopic surgery in the evidence-based frame. CONCLUSIONS: Words that highlight novelty have an important influence on patient preference for robotic-assisted surgery. Emphasizing uncertainty of risks and benefits can mitigate this effect. PACT project: standardized resident handoff implementation improves handoff quality Nicole M Tapia, MD*, Sara C Fallon, MD, Mary L Brandt, MD, FACS, Jesus A Correa, BA, Bradford G Scott, MD, FACS, James W Suliburk, MD, FACS Baylor College of Medicine, Houston, TX INTRODUCTION: Stricter resident work hours require increased patient care transfers, potentially decreasing quality of care. The purpose of this study is to examine the results of a novel handoff method using the mnemonic PACT (priority, admissions, changes, task review). We hypothesize that implementation of the PACT handoff method will improve quality of patient care transfers. METHODS: We performed a hybrid type II study that assessed the implementation and effectiveness of PACT in two hospitals with high patient census and frequent turnover. Pre-intervention (6/2012-8/15/2012) and post-intervention (8/20/2012-2/2013) handoff practices were compared. To assess implementation, handoffs were directly observed by trained medical students, observing if recommended content and order were discussed. To assess

ª 2013 by the American College of Surgeons Published by Elsevier Inc.

Handoff implementation and outcomes

Handoff time (minutes) Patient census (number of patients) Discussion of priority patients Discussion of admitted patients Discussion of changes during shift Discussion of task review Discussion in PACT order Incidence of incomplete tasks during shift Incidence of unknown patient status during morning rounds

n

prePACT

PACT

253 17  13 22  14

p Value

0.003

246 38  16 52  22 <0.001 253

51%

88%

<0.001

250

82%

95%

0.001

252 254 252

87% 59% 3%

97% 91% 22%

0.002 <0.001 <0.001

157

46%

26%

0.006

170

57%

42%

0.047

CONCLUSIONS: Our institution successfully implemented a standardized handoff method which improved handoff quality. PACT handoffs increased task completion, patient knowledge, and emergency preparedness. Future studies will explore checklist integration to enhance PACT process. Human factors methods improve efficiency in emergency trauma care Alexandra Gangi, MD, Ken Catchpole, PhD, Renaldo Blocker, PhD, Jennifer Blaha, MBA, Daniel Shouhed, MD, Bruce L Gewertz, MD, FACS, Eric J Ley, MD, FACS Cedars-Sinai Medical Center, Los Angeles, CA INTRODUCTION: The time interval between the notification of incoming trauma to patients’ arrival in the emergency department can impact trauma care. The implementation of interventions during the emergency department (ED) phase of care should decrease case duration and the number of deviations from the natural progression of care (flow disruptions, FD). METHODS: Trained observers recorded FD and work system variables using a validated tablet-PC data collection tool at a level I trauma center. Trauma cases were observed and FD were recorded.

S100

ISSN 1072-7515/13/$36.00 http://dx.doi.org/10.1016/j.jamcollsurg.2013.07.228