In July 2003 the ACGME 80/30 work hour regulations went into effect. To maintain compliance with these regulations, new systems of care that might include cross cover and patient handoffs were created. Cross cover is defined as the care provided by a physician while the primary physician team is out of the hospital. Handoffs occur when a physician admits a patient and transfers the patient's care to another team of physicians, who assume care of the patient until discharge. At our institution, a night team of house staff covers admissions after 10 pm or after the on‐call team caps, whichever comes first. The patients are handed off to 1 of 4 general medicine ward teams in the morning. Research demonstrates that patient handoffs lead to increased length of stay, more laboratory testing, and medical errors. The purpose of this quality improvement project was to determine the incidence of patient handoffs on the general medicine wards. Patient date and time of admission were used to create a new admitting structure in order to minimize patient handoffs.


Over a 5‐week period from November 20 to December 24, 2006, the time of admission, admitting physician, and final medicine ward team of all patients were collected. During this period, 390 patients were admitted to the general medical service. One hundred and eight‐three patients (47%) were handed off to a general medicine team. Patient admission time demonstrated that 188 patients (49%) were admitted between 5 pm and midnight. A new ward structure was devised that required 1 additional house officer to create an additional general medicine team, which would admit patients during the busiest hours and days of the week. The new admitting structure would allow a 50% increase in the number of patients admitted in one 24‐hour period without relying on float teams to admit overflow patients, thus reducing handoffs. Retrospectively applying the new admitting system to preexisting admissions during an average week demonstrated a 45% reduction in the number of handoffs.


The 80/30 work hour regulations were created to improve patient safety and resident well‐being. Their implementation resulted in increased cross cover and patient handoffs. At our institution handoffs on the general medicine wards made up 47% of all patient admissions. The ability to identify the incidence of handoffs via collection of patient admission data led to the creation of a new admitting structure that will benefit house staff training and continuity of patient care.

Author Disclosure:

P. Gibbons, None.