Luminary Learning Gastrointestinal Disorder- Issue 1

62  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS words, this form of handoff provides a space for co - constructing meaning . Rates of medical error and preventable adverse events in hospitalized children fell significantly after the handoff tool was implemented, which also comprised training and structured changes to where handoffs occurred and who attended them (Starmer et al., 2013). The training included workshops, simulation exer- cises, faculty development tools, and materials to influence institutional culture. It addressed indi- vidual, organizational, and contextual factors linked to both care processes and patient outcomes (Starmer, O’Toole, et al. 2014; Starmer, Spector, et al. 2014). Involvement of nine hospitals in the research provided a multi-centre view of how improved resident handoff could reduce medical errors, preventable adverse events, and communication failures (Starmer, O’Toole, et al. 2014; Starmer, Spector, et al. 2014). In 10,740 patient admissions, the rates of medical error and pre- ventable adverse events decreased significantly without increasing the time required to com- plete handoffs. These results show how structured processes can shape social and organization culture, shift the discourse of a high-risk event, and improve patient outcomes. Similarly, adapting standardized handoff approaches to local practice in 23 children’s hospitals significantly reduced handoff failures (Bigham et al., 2014), highlighting how important it is to contextualize such inter- ventions to institutional cultures. Shared understanding among ‘sender’ and ‘receiver’ during ED patient handoffs and structuring the input of nurses provide space for dialogue is gaining traction (Gopwani, Brown, Quinn, Dorosz, and Chamberlain, 2015). Maximizing the Potential of Using Safety Checklists The use of checklists also improves patient safety. For example, a surgery safety checklist imple- mented in hospitals in many different countries reduced rates of death and complications sig- nificantly (Haynes et al., 2009), although social factors such as the collaborative competence of individual teams (Kitto and Grant, 2014) influence uptake and effectiveness. Similar contextual issues (Dixon-Woods, Bosk, Aveling, Goeschel, and Pronovost, 2011; Dixon-Woods, Leslie, Tarrant, and Bion, 2013) affect the uptake of measures to reduce the rate of potentially lethal bloodstream infections (Pronovost, 2008; Pronovost et al., 2006) associated with insertion of long catheters into the veins of the neck or upper chest in patients in intensive care units to administer medications and fluids. As Bosk and colleagues (2009) note, it is a mistake to view checklists as simple techni- cal solutions for complex sociocultural problems. Indeed, use of checklists may have unintended consequences when implemented in a top-down fashion. Building checklists for interprofessional contexts requires understanding of the politics and complex local power structures as well as cul- tural and relational factors of stakeholder groups (Kitto, 2010). We conclude that both handoff tools and checklists are powerful mechanisms to improve communication and practice-based learning if they are designed and implemented with local context and social factors in mind. Common Themes Relevant for Workplace Learning, Quality Improvement, and CPD The positive patient outcomes demonstrated in quality improvement initiatives linked to inter- disciplinary rounds, handoffs, and the effective use of checklists highlight several key themes of