Failure to synthesize and make available critical information about patients and care plans to cross‐covering physicians represents a predominant cause of decreased quality of care and communication breakdowns. Trainee duty hour restrictions and increased supervisory requirements on faculty has substantially increased the number of patient care handoffs. There is a clear need to train and assess trainees’ in the area of handoff competence. Teaching, role‐modeling and supervision of handoffs when done are often done by inpatient faculty. Nevertheless, most faculty did not train in the era of the new duty hour restrictions where handoffs best practices are more common place. We sought to understand faculty, resident and sub‐intern knowledge of handoffs.
An expert panel developed a nine‐question handoff knowledge test (HKT). Questions addressed the importance of handoffs, the consequences of inadequate handoffs, the Joint Commission’s mandates, and characteristics of a high quality handoff. Feedback from stakeholders was elicited and incorporated into the final survey which also included five published questions. In 2012‐2013, we administered the HKT to our institution’s internal medicine and pediatric hospitalist faculty, as well as all incoming interns. Fourth year medical students on pediatric sub‐internships were also given the HKT at the beginning and end of a handoff curriculum. Analysis of variance compared performance across medical student, resident, and faculty levels. Paired t‐tests compared medical student knowledge test performance before and after training.
37 medical students and 173 interns completed the HKT; 24 out of the 25 hospitalists that were asked to participate completed it. Mean percent correct on the knowledge examination was 60.9% for faculty, 55.0% for incoming interns, 55.7% for medical students prior to instruction and 70.6% after the handoff curriculum. Faculty did not perform significantly better than medical students or interns. Medical students performed better after the curriculum as compared to how they performed before the curriculum (mean difference 14.9, t‐Ratio 6.28, DF 36, p<0.0001.). After the curriculum, students outperformed the faculty (mean difference 9.6, t‐Ratio 2.49, DF 59, p=0.0078).
Faculty do not perform better on a handoff knowledge test than medical students and interns. Student knowledge improved and exceeded faculty knowledge by the end of a handoff curriculum. Our study provides empirical support for patient care handoff training.