Background: Handoffs are critical to safe and efficient transfer of patient care between hospitalists. While patient handoffs are essential to hospitalist practice, there is great variability in handoff content, preparation, and delivery. Our study aimed to characterize handoff practices at a large academic hospitalist group, which primarily utilizes a written handoff platform.
Methods: We conducted an anonymous survey via REDCap of attending hospitalists at two tertiary care academic hospitals in New York. The survey assessed perceived practices regarding handoff preparation, and asked respondents to rate the importance of various clinical care components (e.g. stability, code status) and hospital efficiency information (e.g. estimated discharge date) when both preparing and receiving patient handoffs. Spearman’s correlation was used to measure the relationship between survey responses and hospitalist age and experience; Mann-Whitney Wilcoxon test was used to evaluate gender differences.
Results: Of 71 respondents, 46% were between 35 and 44 years old and 50% identified as female. Over half (54%) had 5 years of experience or less as a hospitalist, and 90% were daytime hospitalists. Less than half (46%) spent longer than 20 minutes preparing handoffs, and 47% spent only 1 day per week preparing or updating patient handoffs. In addition to communicating through the written handoff platform, 42% of respondents usually or always engaged in additional communication with hospitalists assuming care of their patients; 36% of these communications were provided verbally (usually or always).From the perspective of preparing and receiving handoffs, the same top 3 items were rated as very or extremely important: patient stability (99% and 99%), diagnosis (93% and 93%), and tasks that must be completed prior to discharge (90% and 87% respectively). With regard to hospitalist characteristics and handoff practices, female hospitalists rated patient stability (p=0.005), code status (p=0.045), decision maker/healthcare proxy (p=0.019), and anticipated discharge location (p=0.005) with greater importance than male hospitalists when preparing handoffs. When receiving handoffs, female hospitalists again rated code status (p=0.016), decision maker/healthcare proxy (p=0.008), and anticipated discharge location (p=0.005) with greater importance than male hospitalists. When considering provider age and experience, older hospitalists spent a longer time preparing handoffs (r=0.214, p=0.045). Years of experience as a hospitalist was associated with increased reported importance of medical history and pending imaging tests when preparing handoffs (p=0.016, 0.041 respectively). Years of experience was also associated with the perception that handoffs did not provide all information needed to safely care for patients (p=0.002) or identify patients for discharge (p=0.001).
Conclusions: Our study highlights the perceived importance of both clinical and hospital efficiency information on patient handoffs as well as potential associations with hospitalist gender and experience. Future studies will assess these findings across health systems and inform the design of comprehensive handoffs platforms.