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Hosp Pediatr. 2018 Apr;8(4):227-231. doi: 10.1542/hpeds.2017-0173. Epub 2018 Mar 7.

Focused Training for the Handover of Critical Patient Information During Simulated Pediatric Emergencies.

Author information

Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
Divisions of Critical Care Medicine and.
Departments of Anesthesiology and Critical Care Medicine and.
General Pediatrics and.
Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland.



Miscommunication has been implicated as a leading cause of medical errors, and standardized handover programs have been associated with improved patient outcomes. However, the role of structured handovers in pediatric emergencies remains unclear. We sought to determine if training with an airway, breathing, circulation, situation, background, assessment, recommendation handover tool could improve the transmission of essential patient information during multidisciplinary simulations of critically ill children.


We conducted a prospective, randomized, intervention study with first-year pediatric residents at a quaternary academic children's hospital. Baseline and second handovers were recorded for residents in the intervention group (n = 12) and residents in the control group (n = 8) during multidisciplinary simulations throughout the academic year. The intervention group received handover education after baseline handover observation and a cognitive aid before second handover observation. Audio-recorded handovers were scored by using a Delphi-developed assessment tool by a blinded rater.


There was no difference in baseline handover scores between groups (P = .69), but second handover scores were significantly higher in the intervention group (median 12.5 [interquartile range 12-13] versus median 7.5 [interquartile range 6-8] in the control group; P < .01). Trained residents were more likely to include a reason for the call (P < .01), focused history (P = .02), and summative assessment (P = .03). Neither timing of the second observation in the academic year nor duration between first and second observation were associated with the second handover scores (both P > .5).


Structured handover training and provision of a cognitive aid may improve the inclusion of essential patient information in the handover of simulated critically ill children.

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