Clear Conversations: A Comprehensive Curriculum to Facilitate Translation of Skills Learned in Simulated Settings to Improve Communication in Real Clinical Encounters (FR482E)

Objectives Develop and validate a template for patient handoffs from the hospital to hospice. Create an interactive didactic to teach this handoff to physicians and nurses in training. Develop a direct observation evaluation tool for hospital to hospice handoffs that meets ACGME requirements for handoff assessment. Background. Patient handoffs are an increasingly emphasized skill in medical and nursing education. The Accreditation Council for Graduate Medical Education (ACGME) includes transitions in care as one of the key components of their Clinical Learning Environment Review (CLER) program. All hospice and palliative medicine fellowships must demonstrate curricula to teach and evaluate handoffs. Palliative medicine nurse practitioners and hospice nurses also perform handoffs regularly. Traditional handoff tools emphasize transitions that may not apply in hospice and palliative medicine (floor to ICU, day shift to night shift). In addition, these handoff tools lack content that is unique to hospice and palliative medicine. Methods. Seven hospice physicians, nurse practitioners, and nurses were interviewed to determine core content for a hospital to hospice handoff. This content was used to create a handoff template. The same hospice providers reviewed the handoff template for validation. The handoff template was taught to two groups of palliative medicine fellows and one group of internal medicine residents using an interactive didactic and role play. Feedback was obtained to further refine the handoff template. A direct observation assessment tool was then developed to mirror content in the handoff template. Results. The hospital to hospice handoff template and didactic received positive evaluations from palliative medicine fellows and residents. The direct observation assessment tool was successfully implemented in a palliative medicine fellowship to meet ACGME requirements for handoff assessment. Discussion. ACGME requirements for handoff education and assessment must be adapted to hospice and palliative medicine. The hospital to hospice handoff is an ideal handoff to emphasize in palliative care education because it requires trainees to determine which information is relevant for patients with comfort-focused goals. It can also be formally assessed to meet ACGME requirements for the CLER program. Conclusion. Our comprehensive curriculum (hospital to hospice handoff template, didactic with role play, direct observation assessment tool) fulfills requirements and also ensures smooth transitions from the hospital to hospice. It can be easily adapted to other disciplines including nurses and advanced practice providers.