Background:
Transitions of care occur any time a patient moves from 1 care setting to another or from 1 provider to another. A higher frequency of errors has been described during these vulnerable periods, and a Society of Hospital Medicine Task Force has issued recommendations for best practices in handovers among hospital‐based physicians. We describe an effort at 1 institution to improve handover practice.
Methods:
Twenty hospital medicine physicians were surveyed to assess satisfaction with current handover practice and perceived errors. Using survey results, an institutional task force identified barriers to safe handovers and recommend the 2 changes in practice: (1) mandatory verbal handover of all new patients by the admitting physician to the accepting team and (2) extension of the night shift by 1 hour to establish daily overlap for face‐to‐face interaction with day shift. Three months after these changes were implemented, physicians were resurveyed. End points were estimated medical error rates, provider satisfaction, and length of stay (LOS) index, a standardized LOS adjusted for diagnosis.
Results:
The surveys had a 100% response rate. Initially, 30% of providers reported that minor medical errors, errors not resulting in patient harm, occurred “somewhat often”; after the changes, only 4% of providers reported “somewhat often” (P < 0.05). Providers also reported fewer major medical errors; 56% of physicians reported 1 or more events in the 3 months prior to the first survey. Only 24% reported major errors in the subsequent 3 months. Although not statistically significant, there was also a trend toward improved satisfaction with overnight hand‐offs. Thirty‐nine percent of providers reported themselves as “very satisfied,” versus 21% pre‐change. Physicians did not report greater satisfaction with hand‐offs during the day shift, during which physicians were mandated to give a verbal sign‐out but did not have a specified time to do so. Comments suggested that this may have been because of too many work flow interruptions. The LOS index was 0.968 before the intervention and 0.905 after (P < 0.01).
Conclusions:
Mandating verbal handovers and dedicating time for sign‐out was associated with estimates of fewer medical errors, greater physician satisfaction with handovers, and lower LOS index. Mandating verbal handovers without dedicating time to do so was associated with lower physician satisfaction, presumably because of interruptions in work flow. These findings suggest that dedicated time for verbal handovers may have positive effects on the quality and efficiency of hospital practice.
Disclosures:
J. Bonsall ‐ none; W. Smith Jr. ‐ none; K. Qatsha ‐ none; A. Webb ‐ none; Z. Wiley ‐ none; N. Maleque ‐ none; V. Akopov ‐ none