Optimizing trainee handoffs on a busy transfusion medicine service

Abstract Objective Within the healthcare system, handoff processes are critical to maintain safety & continuality of care. Many handoff platforms exist for clinical inpatient housestaff specialties. However, these do not always align with the needs of clinical pathologists. Academic transfusion medicine (TM) services often oversee a hybrid of laboratory management, clinical services including apheresis therapy, and blood product management. To date, the literature is limited in describing the effectiveness of TM handoff in addressing these needs. Methods Our institution transitioned from using Microsoft Word document-based handoff to a Microsoft Sharepoint, browser-based handoff accessible via campus intranet or virtual private network (VPN). A verbal handoff accompanying the document remains unchanged. The previous Word document-based handoff followed the known structured communication framework (situation, background, assessment, and recommendation (SBAR)) structure for each patient. This document could only be concurrently edited by one user and was distributed via closed-loop encrypted email to ensure Health Insurance Portability and Accountability Act (HIPAA) compliance. The new Sharepoint-based handoff features an expanded format including patient name/medical record number (MRN), date of contact, category of service, history, assessment and a task (to-do) list. This site can be concurrently edited and viewed by multiple users. It is version-controlled and searchable. It is also customizable to enable tracking of issues that are not associated with a MRN, such as product inventory, on-call staffing, and product investigation. Six months following the handoff transition, trainees’ feedback towards both formats were solicited with a Likert scale-based survey. The survey was open to any trainee that had rotated on the TM service, regardless of whether they had experienced both handoff formats. Handoff measures that were surveyed included effectiveness at communicating important information, ease of use, time spent, impact on patient care, amount of detail, integration in patient management and general attitudes towards TM call. Trainee demographics were also collected. Results Out of 18 potential participants, 15 trainees responded to the survey. Trainees reported that the Word document-based handoff contained significantly more extraneous detail, took excessive time to write and required more time overall to draft compared to the Sharepoint-based handoff (all p=<0.05). They also found that the Sharepoint-based handoff was significantly easier to use compared to the Word document-based handoff (p=<0.05). Additionally, the Sharepoint-based handoff was reported to convey important information more effectively and reduced the duration of verbal handoff compared to the Word document-based handoff, though these were not statistically significant. Conclusions TM services have unique responsibilities and benefit from customized handoffs with discrete categories that reflect the TM service’s distinct role. Such structure can help create a more standardized, focused handoff that requires less drafting time and improves efficiency and user satisfaction.