ABSTRACT
BACKGROUND: Poor-quality handoffs are a significant cause of preventable medical errors and adverse events. Handoff checklists improve handoffs but adherence to these tools is often inconsistent. In our study we aimed to investigate the effects of simulated handoff workshop and clinical instruction on resident handoff quality. METHODS: A three-week pre-education intervention observation period of handoffs was conducted to assess the deficits, variability, and common practice in handoffs at the University of Minnesota Fairview Hospital. An institution specific handoff tool was then created by expert anesthesiologists at the University of Minnesota. A prospective observational assessment was then performed one year later to evaluate CA-1's adherence to the content of a standardized handoff checklist in the intraoperative and post-anesthesia care unit environment after exposure to current educational techniques. RESULTS: With introduction of a handoff checklist tool, CA-1 residents included 70.70% (±0.11%) of handoff checklist information in their handoffs during the pre-workshop phase. Following a 2-hour simulated workshop on standardized handoffs, CA-1 residents still only included 70.00% (±0.02%) of handoff checklist information in their handoffs. CA-1 residents included 43.50% (±0.12%) of handoff checklist information in their handoffs at 6 months following the workshop. A one-way analysis of variance revealed a significant difference between the groups F(4, 135) = 18.83, p<0.05. CONCLUSIONS: The current method of education for handoffs does not ensure resident adherence to a standardized handoff technique. We propose that the inclusion of a written or electronic handoff checklist should be enforced and refresher courses should be administered early and frequently.
ABSTRACT
Delusional parasitosis (DP) is a rare form of somatic delusions where a person believes that he or she is infected with worms, bugs, or other parasites. In the literature, DP has been discussed as a presenting feature of cortical dementias but has not been documented as a presenting feature in subcortical dementias such as HIV-associated dementia. We present a case of a 56-year-old male referred from the dermatology clinic for neuropsychological assessment after presenting with persisting claims that he was infected with "bugs" despite evidence to the contrary. The patient had a history of HIV and substance abuse. The patient was diagnosed with dementia due to HIV disease and psychosis due to dementia (i.e., DP) based on the neuropsychological evaluation. This case report suggests that neuropsychological evaluations may be indicated for patients presenting with DP and risk factors for either cortical or subcortical dementias such as HIV-associated dementia.
