Background: Inpatient handoffs have been recognized as a vulnerable time during a patient’s hospitalization and are widely associated with adverse events and near misses. A variety of strategies have been implemented in order to improve shift handoffs. To date, no study has described how residency program leadership views these strategies, or how the implementation of these strategies would affect the hospitalized patient’s experience. Our objective was to characterize the use of best practices in resident handoffs and evaluate the association with internal medicine program director (PD) satisfaction and patient experience scores.
Methods: We combined and analyzed the 2014 Association of Program Directors in Internal Medicine (APDIM) survey results with the Center for Medicare and Medicaid Service’s Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey results. APDIM handoff survey items surveyed properties of written and verbal handoffs and educational interventions. Primary outcomes included PD satisfaction with the handoff process, and HCAHPS survey items that assessed the 5-star composite scores regarding doctor communication, pain management, hospital rating, hospital recommendation, and overall summary rating for the primary affiliated hospital for each corresponding residency program. Each outcome variable was measured on a 5-point scale and dichotomized for analysis. Multivariable logistic regression models controlling for institution-specific characteristics tested associations between PD satisfaction and both handoff properties and HCAHPS patient experience outcomes.
Results: In total, 234/361 (65%) of all APDIM member programs responded, with 208/361 (58%) responding to all of the handoff questions. Most program directors (60%) were satisfied with the handoff processes that were used during shift changes. Employing a dedicated room (OR 3.18; 1.34-7.58), supervision by a senior resident (OR 2.44; 1.26-4.74), paper copies of sign outs for receivers (OR 2.32; 1.11-4.88), and interactive workshops (OR 2.17; 0.95-4.96) were positively associated with PD satisfaction, but were not associated with any patient experience outcomes. Use of Electronic Health Records (EHR) for the creation of a written handoff was associated with PD satisfaction (OR 4.15; 1.51-11.37) and patient’s overall rating of their hospital care (OR 3.07; 1.43-6.58) and Summary Star rating (2.24; 1.00–5.02). PD reported application of these measures ranged from 26% for interactive workshops to 59% for receiver obtaining a written copy of sign-out.
Conclusions: While several handoff strategies are related to PD satisfaction, only the use of an EHR-based written handoff was shown to be associated with higher HCAHPS scores. With less than half of all respondent programs utilizing an EHR-based handoff, this may represent an underutilized resource in patient handoffs, and may represent a future target for meaningful use criteria.