To report on the efficacy of an intervention to improve hand-offs in our residency program.

From July 2018-April 2019 (6 2-week rotation blocks), a hand-off ratio was calculated for each senior resident (SR), and for each team (stroke and general) by a resident who was not rotating on the neurology service. The hand-off ratio was defined as the number of completed handoffs divided by the number of patients per team. In July 2019, a standardized template was implemented and the SR on the team was held responsible for completion. We provided bi-weekly positive and negative feedback. The study was repeated between Feb 2020-May 2020 (6 2-week rotation blocks). In addition, we evaluated the effect of class (PGY level) on hand-off ratio. All results were analyzed by ANOVA tests and an independent sample t-test.

Prior to intervention, two-way ANOVA of “resident”  and “team” showed a significant effect of “resident” (F(8,939)=43.831, p=<0.001), but not of “team” (F(1,939)=1.024, p=0.312) on the hand-off ratio, identifying resident intervention as the target to improve hand-offs. Independent sample t-test demonstrated a significant difference in adherence before (M=0.145,SD=0.300) and after intervention (t(1904)=43.1,p<0.001). One-way ANOVA to examine the effect of “class” on hand-off ratio showed a significant effect of “class” (F(3, 1902)=680,p<0.001).

Introduction of a standardized template with continued feedback led to a significant increase in adherence of our residents to complete a written hand-off. This change in culture benefited the youngest classes the most.