Background: Patient pass-offs represent a known vulnerability in patient care. The Hospital Medicine Unit at Massachusetts General Hospital has several specialized roles including an admitting hospitalist, a rounding hospitalist, and a nocturnist. Our on-service time is typically four or five days in a row. Our hospitalists and nocturnists work in six hour, ten hour and twelve hour shifts and do not arrive and leave at the same time. While these operational characteristics have improved work efficiency and job satisfaction, they have also introduced a greater number of patient pass-offs. We therefore wished to assess the quality of patient pass-offs by surveying our staff.
Purpose: To measure and then improve the quality of patient pass-offs in a large academic hospital group, compromising 70 hospitalists, on multiple different medical services, involving multiple different clinical roles.
Description: We focused on evaluating the four most common patient pass-offs: (1) pass-off of an admitted patient from hospitalist to hospitalist at change of shift, (2) pass-off of a list of patients from nocturnist to hospitalist at change of shift, (3) pass-off of a list of patients from hospitalist to nocturnist at change of shift, and (4) pass-off of a list of patients from hospitalist to hospitalist at the end of service. Four surveys were created, one for each pass-off situation. Each survey contained three questions, each question encompassing one of three general domains: (1) documentation of patient care, (2) communication of significant events, and (3) overall clinical management. Work within each of these three domains is rated by the reviewer on a scale of 1 (Poor) to 4 (Exemplary).
So far, we have received 46 surveys gathered over three weeks. There were no surveys where the reviewer found work that deserved a score of 1. There were twenty-one surveys on patient list pass-off at the end of service. 100% of the scores in all three domains were 3’s or 4’s. There were eight surveys on patient admission pass-off at change of shift. 100% of the scores in documentation and clinical management were 3’s or 4’s. 25% (two of eight surveys) of the scores in communication were 2’s, the remainder were 3’s or 4’s. There were 15 surveys on patient list pass-offs from hospitalist to nocturnist at change of shift. 100% of the scores in documentation and clinical management were 3’s or 4’s. 13% (two of 15 surveys) of the scores in communication were 2’s, the other score were 3’s or 4’s. There were two surveys on patient list pass-offs from nocturnist to hospitalist at change of shift. 100% of the scores in documentation and clinical management were 3’s. One of the scores in communication was a 2, the other score was a 3.
Conclusions: Our pass-off surveys shows that the quality of documentation and clinical management remains very high despite an increase in the number of patient pass-offs. However, we have created lapses in communication because our hospitalists and nocturnists do not arrive and leave at the same time now. Pass-offs represent an ideal time for hospitalists to evaluate the work of their colleagues. Our simple three question pass-off survey requires little time to do, yet has the potential to become a powerful tool to improve the work of individual hospitalists and the overall operations of the Hospital Medicine Unit.