Background:
The Society of Hospital Medicine (SHM) has made hand‐offs one of the core competencies of hospital medicine and released recommendations for hospitalist hand‐offs. To date, most hand‐off studies have focused on the sender. A recent study suggested that despite optimal conditions for senders, significant information is still lost, highlighting the need to examine the role of the receiver. We aimed to observe and characterize the behaviors of hand‐off receivers on an academic hospitalist service.
Methods:
Hospitalist hand‐offs were directly observed by a trained third‐party observer at a single academic medical center using the paper‐based listening checklist. The listening checklist was developed following a review of relevant listening literature, including prior hand‐off, organizational, psychological, cognitive science, and medical literature, and expert review. The checklist has 3 domains: (1) displays of understanding, which quantifies passive listening behaviors such as nodding and affirmatory statements; (2) processing information, which focuses on active listening behaviors such as note taking and questioning; and (3) interruptions/distractions. The checklist was piloted on the hospitalist service from June to November 2010. Descriptive statistics were performed and, where appropriate, 2‐sided t tests, to compare passive and active listening behaviors.
Results:
Forty‐eight hand‐offs were observed and assessed utilizing the listening checklist. Receivers displayed active listening behaviors significantly less frequently than passive listening behaviors (0.89 vs. 1.65, on a 0–3 scale, per hand‐off; P < 0.001). Read‐back occurred 8 times (16.7%), and in 11 hand‐offs (23%), receivers took notes. The mean number of questions asked per hand‐off was 2.1, with 67% directly related to hand‐off content and 33% related to systems/other issues (mean, 1.42 vs. 0.69 per hand‐off, P = 0.003). Almost all hand‐offs observed (98%) had at least 1 interruption, and the median number of interruptions per hand‐off was 3, ranging from 0 to 12 interruptions per hand‐off. The most frequent interruptions noted were: side conversations (42%), clinicians arriving for hand‐off (15%), and pagers going off (19%). Side conversations occurred at least once in nearly three fourths of hand‐offs (72%), and the number of side conversations per hand‐off ranged from 0 to 5. Side conversations ranged in content from personal to job‐related topics. The number of interruptions was also directly related to patients discussed. (r = 0.56, P = 0.0025)
Conclusions:
Direct observation of hospitalist hand‐offs revealed that receivers rarely use active listening behaviors, like note taking and read‐back, which are recommended to enhance memory. Furthermore, hand‐offs, especially with more patients, were characterized by frequent interruptions, the most common of which were side conversations and clinicians arriving for the hand‐off, both of which are potentially modifiable targets for improvement.
Disclosures:
E. Greenstein ‐ research funding, AHRQ R03 grant 1R03HS018278‐01; NIA T35 grant 5T35AG029795‐02; V. Arora ‐ research funding, AHRQ R03 grant 1R03HS018278‐01; NIA T35 grant 5T35AG029795‐02; P. Staisiunas ‐ research funding, AHRQ R03 grant 1R03HS018278‐01; NIA T35 grant 5T35AG029795‐02; J. Farnan ‐ research funding, AHRQ R03 grant 1R03HS018278‐01; NIA T35 grant 5T35AG029795‐02