Background: Inpatient service handoffs have been recognized as a vulnerable time during a patients’ hospitalization. Prior studies have suggested the need for more systematic, team-based, and patient-centered handoff models. We hypothesized that performing the service handoff at the patients’ bedside may more efficiently transfer patient information between physicians, while further integrating the patient into their hospital care.
Purpose: Our aim was to describe and assess the implementation of a bedside handoff (BHO) at hospitalist service transitions.
Description: We performed a 4-month prospective study of a BHO on a non-teaching hospitalist service in which service transitions occurred every 7 days. Each week, 1 out of 3 possible services was scheduled to perform the service handoff at the bedside. Oncoming hospitalists in the BHO group were scheduled to a day admissions service the day prior to taking over a clinical service – which allowed for both oncoming and outgoing hospitalists to be in the hospital at the same time. Oncoming physicians were asked to co-round at the patient’s bedside with the outgoing physician during this shift. Both participating physicians were surveyed within 48-hours of the BHO. Surveys assessed for completeness of handoff, communication, missed information, and near misses/adverse events due to incomplete handoffs. Physicians not scheduled to perform the BHO were also surveyed to ascertain differences between the two groups. Responses were dichotomized and chi-square analysis was used to assess differences.
From July to November 2015, 13/17 (76%) of scheduled BHO occurred, with 4.2 patients undergoing a BHO/service transition, with the majority (92%) of BHO taking 16-60 min to complete. Post-handoff survey response rate was 100% in both intervention and control groups. Physicians who performed the BHO (n=13) reported statistically higher rates of completeness of information exchange (100 vs. 50%, p=0.005), less time reviewing the patient’s hospital course on the first day of service (38 vs. 73%, p=0.03), less missed information that should have been discussed at the transition (8 vs. 63%, p=0.007), and perceived higher patient awareness of the service transition (69 vs. 25%, p=0.049) compared to physicians who did not perform a BHO (n=8) at the service transition. Narrative feedback from physicians revealed positive attributes that centered on a theme of better knowledge of the patient. The primary negative response was that the BHO was time-consuming and difficult to coordinate.
Conclusions: While performing a BHO may be time and resource-intensive, physicians reported improved and more efficient information exchange, along with a perceived improvement in patient awareness of care transitions. Further studies are needed to assess patient-level outcomes and perceptions of a bedside handoff.