Medical error is a significant public health problem. Miscommunication between medical providers has been noted to be involved in > 60% of medical error. Accreditation organizations and expert reviews have both called for efforts to improve and standardize medical communication, following models that have been successful in other high-risk fields such as aeronautics. Patient handoffs, particularly in high-volume and high-acuity settings, are a particularly vulnerable point in the patient care system. Such handoffs occur in noisy, chaotic settings and are notable for their free-form and variable nature. In the National Patient Safety Goals for 2006, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recommended standardization of handoff procedures. Our institution will attempt to satisfy JCAHO's request by implementing a patient handoff that uses the electronic medical record (EMR). The aim of this project is to integrate health information technology (IT) systems and simulation-based training to reduce communication errors between resident physicians in an emergency department (ED) setting. Initially, a 3-month observation of actual ED handoffs will provide baseline handoff characteristics. This data will be collected by direct observation using a structured checklist. Concurrent with the introduction of the handoff tool, we will conduct a 4-hour standardized patient and mannequin simulation-based training program to instruct residents in both the use of the handoff tool and the fundamentals of structured, consistent communication. This educational intervention will be offered to residents rotating in the 1st, 3rd, and 5th months after the implementation of the EMR tool. Direct observation of handoffs in the ED will continue for 6 months. This will allow discrimination of the effect of the training and the EMR-based tool on communications individually. We hypothesize that the combination of simulation-based training (with practice and feedback) and a health IT tool will provide the greatest benefit and result in significantly fewer communications errors, therefore increasing patient safety. This project is relevant to health care organizations, accreditation bodies, and governmental bodies. Consistency in communication is a necessary step to reduce communication error. Integration of on-the-job tools with robust training is necessary if improvement in communication is to be accomplished and maintained. [unreadable] [unreadable] [unreadable] [unreadable]