Institution
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Arkansas Children's Hospital Boston Medical Center Brigham and Women's Hospital Children's Hospital of Michigan Hurley Medical Center Intermountain Medical Center Levine Children's Hospital at Carolinas HealthCare System Maimonides Medical Center Mayo Clinic New York Hospital Queens Sunnybrook Hospital Trident Medical Center University of California Medical Center University of Cincinnati University of Hawaii John A Burn School of Medicine Virginia Commonwealth University Hospital Children's Hospital of Philadelphia New Hanover Lankenau Medical Center Children's Hospital Montefiore Children's Hospital Colorado University of New Mexico Hackensack UMC Mountainside Medical University of South Carolina Sparrow Hospital Johns Hopkins Baltimore Children's National DC Toledo Children's Hospital AtlantiCare Regional Medical Center Sanford Children's Hospital Gwinnett Medical Center Children's Mercy Kansas City Boston Children's Hospital North Shore Hospital Mount Auburn Hospital Bryn Mawr Hospital Beth Israel Deaconess Hospital-Milton
Today M-D-Y
Provider/Resident SHM.I-PASS ID number
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Service / Unit Name
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Service / Unit Name
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Wards Cross-cover
Service / Unit Name
* must provide value
Yellow Team Pediatric Hospitalist
Service / Unit Name
* must provide value
FIRM
Service / Unit Name
* must provide value
Hospitalist Inpatient
Service / Unit Name
* must provide value
General Medicine
Service / Unit Name
* must provide value
Team 1 Team 2 Inpatient
Service / Unit Name
* must provide value
Team 1 Team 2 Team 3 Team 4 Team 5 Team 6 Team 7 Team 8 Night Float
Service / Unit Name
* must provide value
Zinkham Neill
Service / Unit Name
* must provide value
5E 5W Hybrid
Service / Unit Name
* must provide value
IPS
Service / Unit Name
* must provide value
Academic Team
Service / Unit Name
* must provide value
4WCSH 7WMHT
Service / Unit Name
* must provide value
CHAM 6
Service / Unit Name
* must provide value
Blue Team Purple Team
Service / Unit Name
* must provide value
MICU
Service / Unit Name
* must provide value
Red Team Teal Team Purple Team Green Team
Thank you for participating in the I-PASS Handoff Program. This survey is meant to be completed at the end of an inpatient rotation or period of service. The survey will ask you about your work and educational experiences and your experiences with teamwork and handoffs in particular. Results will be used to improve the quality of care and training, and for research; aggregate results may be published, but no data that would make it possible to identify individual respondents will be shared with your supervisors, program directors, or anyone other than individuals participating in this project. Protection of your confidentiality will be of the highest priority. We will be using the data obtained from this survey as part of a research study approved by the Boston Children's Hospital Institutional Review Board to understand more about patterns across institutions about handoff and teamwork education, supervision, and improvement efforts. Your willingness to complete this survey will be considered consent to participate in this research study.
We understand that you may not remember all details perfectly, but please make your best guess . You are free to skip any question you would prefer not to answer, but we encourage you to answer all questions, as complete data will improve the value of the survey.
1a. Please provide the length of your most recent completed inpatient work rotation/experience (eg 4 week inpatient block or 1 week duration as ward supervisor)
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Weeks
1b. Please provide the end date of your most recent completed inpatient work rotation/experience:
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Today M-D-Y
PLEASE NOTE: Except as otherwise noted, all subsequent questions on this survey will refer to this specific inpatient experience and duration< /font> 2. Which of the following best describes your specialty / training program?
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Internal medicine Surgery Pediatrics Other
2. Which of the following best describes your area?
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Surgery Medicine ICU Other
Other
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Other
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3. What was the primary setting of your last inpatient work experience?
General inpatient ward Subspecialty ward Intensive care unit (any type) Other
Other
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4. Which of the following best describes your role?
Resident physician
Subspecialty fellow
Attending physician
Medical Student
Registered nurse
Nurse practitioner
Physicians' assistant
Respiratory therapist
Physical therapist
Occupational therapist
Other
4. Which of the following best describes your role?
Attending physician
ICU Attending
Hospitalist Attending
Other Attending
Registered nurse
Nurse practitioner
Physicians' assistant
Respiratory therapist
Physical therapist
Occupational therapist
Other
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Other
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5. If you are a resident physician, what year of your residency program are you in?
Post graduate year 1 (PGY1)
PGY2
PGY3
PGY4
PGY5
PGY6
PGY7 or more
Please rate your level of agreement with the following two statements:
9. I trust that the information in the written handoff is accurate and up to date
Completely disagree Somewhat disagree Somewhat agree Completely agree N/A
10. I trust that the information in the verbal handoff is accurate and up to date
Completely disagree Somewhat disagree Somewhat agree Completely agree N/A
Problems with handoffs led to other errors or patient harm (please describe):
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Please keep these definitions in mind when answering the next two questions:
Minor Harm- Limited clinical consequence--such as a need for more frequent monitoring or transient discomfort, without prolongation of hospitalization, significant organ dysfunction or worsening of clinical condition.
Major Harm- Significant clinical consequences such as deterioration in clinical status, organ dysfunction, prolonged hospitalization, disability beyond discharge, or death.
33. In your most recently completed rotation or period of service , estimate the number of your patients you believe experienced a minor harm as a result of a problematic handoff.
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Patients
34. In your most recently completed rotation or period of service , please estimate the number of your patients you believe experienced a major harm as a result of a problematic handoff.
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Patients
35. During your last inpatient experience, on how many occasions did a supervisor (eg attending or chief resident):
Observe you giving handoff?
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Occasions
Give you verbal or written feedback after observing you giving handoff?
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Occasions
Observe you receiving handoff?
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Occasions
Give you verbal or written feedback after observing you receiving handoff?
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Occasions
Review your written handoff document for purposes of giving feedback?
* must provide value
Occasions
Give you verbal or written feedback after reviewing your written handoff document?
* must provide value
Occasions
39. Did you receive any training over the past year about handoff skills ?
Yes No
40. If yes, rate the overall quality of training you received about handoff skills over the past year:
Poor Fair Good Very good Excellent N/A
41. Did you receive any training over the past year about teamwork skills ?
Yes No
42. If yes, rate the overall quality of training you received about teamwork skills over the past year:
Poor Fair Good Very good Excellent N/A
43. How many days did you work during your last inpatient experience?
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Days
44. On average, approximately how many patients did you cover when working during the day?
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Patients
45. How many nights did you work during your last inpatient experience?
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Nights
46. On average, approximately how many patients did you cover when working during the night?
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Patients
47. Including both days and nights, how many hours per week did you work?
Hours per week
48. On average, how much sleep did you get per 24 hours over your last inpatient experience?
Hours of sleep per 24 hours
49. In general, how effectively did faculty / supervisors teach during your last inpatient experience?
Not at all Slightly Moderately Well Very Well Extremely Well
50. In general, how effectively did faculty / supervisors supervise during your last inpatient experience?
Not at all Slightly Moderately Well Very Well Extremely Well
51. Over the course of your most recent inpatient experience, how effectively did your supervisors balance supervision with allowing you independence?
Not at all Slightly Moderately Well Very Well Extremely Well
47. How would you rate the overall quality of your last inpatient experience?
Poor Fair Good Very good Excellent
Thank you very much for completing this survey!
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