Background: To address safety risks with transitions from hospital to home, the IMPACT collaborative designed, tested and implemented the Pediatric Patient Centered Care Transition (PACT) Bundle. The bundle element “perfect” handoff (timely and complete) aimed to improve hospitalist handoff to outpatient providers at hospital discharge.Our objective was to assess outpatient medical provider’s perceptions of hospitalists’ handoff following bundle implementation.
Methods:
In March 2015, 4 pilot sites conducted an electronic, anonymous survey of 120 randomly selected primary care providers. In addition, 2 pilot sites surveyed 58 subspecialists who provide care for technology-supported patients in the outpatient setting. This 15-item survey assessed timeliness and completeness of discharge communication along with questions about medical provider demographics. Mean satisfaction scores were determined and compared between PCPs and subspecialists. The association between “perfect” handoffs and satisfaction was also assessed and compared. Descriptive statistics and multivariable regressions were calculated.
Results:
Out of 89 providers (58 PCP and 31 subspecialty) 78% practiced in large practice settings (hospital based, private or government clinics) with median 12 years in practice. Handoff was perceived as well-organized (58%) and was received reliably (57%). Most physicians had access to an electronic health record (EHR), but only 33% received handoff instantly (integrated EHR). Handoffs were “perfect” 78% of the time. As compared to PCPs, subspecialists were significantly more dissatisfied about the completeness of hospitalist handoff (p< 0.001, CI 0.65 – 1.68). “Perfect” hand-off rate did not correlate with satisfaction (p=0.98). Subspecialty status was the only independent predictor of dissatisfaction (P <0.001).
Conclusions: Although PCP’s reported greater satisfaction with hospitalist’s handoff than subspecialists, it is likely that high reliability rates of “perfect” handoff (90% or higher) are needed to ensure optimal handoff. Subspecialists’ dissatisfaction will require further investigation to determine the optimal content of discharge information needed to care for technology-supported patients. Health information technology/exchange between inpatient and outpatient providers is likely to further facilitate “perfect” handoff.