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Trauma Morning Report is the Ideal Environment to Teach and Evaluate Resident Communication and Hand-Offs in the 80-Hour Work Week
*Mary E. Ottinger, *Daithi S. Heffernan, *Sean F. Monaghan, *Andrew Stephen, *Shea C. Gregg, *Michael D. Connolly, David T. Harrington, *Charles A. Adams Jr., William G. Cioffi
Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
Objective:The 80 hour work week has raised concerns that complications may increase due to multiple hand-offs or poor communication. Trauma Surgery manages complex trauma and acute care surgical patients with rapidly changing physiology, clinical demands and a large volume of data that must be communicated in order to render safe effective patient care. Trauma Morning Report format may offer the ideal situation to study and teach hand-offs and resident communication.
Participants:Surgery Residents were assessed on a 1 to 5 scale for their ability to communicate 10 critical points of the patient’s presentation, treatment and work up in the trauma bay.
Main Outcome Measures: Residents were assessed for pertinent positives and negatives, as well as overall clarity of communication. In the initial phase, residents were unaware of the evaluation process. The second phase followed a series of resident education sessions about effective communication, hand-offs techniques and detailing how they were being evaluated.
Results: 50 patient presentations in the initial phase and 350 second phase presentations were evaluated. Communicating primary survey and diagnostic X-ray studies improved from 7.5 to 15 out of 20 (p=0.001). Chief complaint, secondary survey and relaying pertinent positive & negatives improved from 4 to 11 out of 15 (p=0.005). Reporting details of resuscitations & patient disposition improved from 7 to 12 out of 15 (p=0.003). Overall clarity of presentation improved from 3 to 4.25 out of 5 (p=0.03).
Conclusions: Trauma Surgery manages complex surgical patients, with rapidly changing physiologic and clinical demands. Trauma Morning Report, with multiple surgical attendings and residents, is the ideal venue to teach and evaluate hand-offs in real time and instill good communication skills in surgical residents.
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