Background: Handoffs are a reality of inpatient medical care and a potential source of patient care errors. Incomplete care transitions during service changes are associated with uncertainty of patient care plans and can result in threats to patient safety. However, frequent hand-offs are often unavoidable given demand to create sustainable schedules to avoid physician “burnout.”
Methods: Pre-intervention surveys were distributed to our academic hospitalist group in September 2013 to assess the need to modify the current service change handoff practices. Survey items included items related to time to prepare the written handoff as well as satisfaction with the completeness and organization of the written handoff when picking up service. In response to this survey, we created a standardized sign-out procedure for our handoffs (Table 1.) Six months after implementing the new standardized written template, we administered a post-intervention survey that mirrored the prior survey with additional items assessing usefulness of the new template. Additionally, we are piloting a real-time survey that faculty complete on their first day of service, asking about the readability and completeness of the handoff they just received.
Results: The response rate for our pre-intervention survey was 69% (n=29.) In this survey, 58.6% (n=17) of respondents spent more than 15 minutes on the first day of service attending to issues that weren’t adequately reported in sign-out, with 27.6% (n=8) spending more than 30 minutes on such issues. The most common elements missing from the sign-outs were past management of the relevant hospital course (62%), immediate future plan (62%), and disposition details (58%.) In our post-implementation survey, the response rate was 52.3% (n=22.) Most respondents (86.4%) reported using the template frequently or always. Post-implementation of the standard template, 95.4% of the respondents infrequently or never experienced events that could have been prevented had it been included in sign-out. Ninety percent of the respondents felt that the sign-out they received had improved with the new written template, while 68% felt the new template improved the sign-out they give. Preliminary data from the real time handoff survey suggest that most faculty are using the template (73%), and overwhelmingly our sign-outs include the immediate future plan needed to transition care for the patients (93%.)
Conclusions: In our small, single institution study, a standardized written template for handoffs at the time of service change has improved the readability and completeness of our handoffs as well as hospitalist satisfaction with handoffs. Our next step is to pilot an evidence-based checklist we developed to assess the quality of our written handoffs more objectively.
Table 1.
Required |
Patient Name/MRN/Location |
Reason for Hospitalization and Relevant Hospital Course (2-3 lines) |
|
Immediate Future Plan (Action Items) |
|
Active Consults |
|
Disposition (date, anticipated needs prior to discharge) |
|
Code Status |
|
Optional |
Point of contact/HPOA (if patient is not the primary point of contact or there is a complex social situation |