Background: Communication errors in the post-operative period have been shown to contribute to patient harm and excess costs. There are no existing standards for the verbal handoff of post-operative patients to the acute care inpatient unit. There is limited literature describing hospitalist and surgeon experiences of and preferences for such handoffs. Our aim was to compare the experiences and preferences of pediatric hospitalists and surgeons about the content and timing of the handoff of patients being admitted post-operatively to the acute care inpatient unit.
Methods: This was a cross-sectional multisite survey of pediatric hospitalists and surgeons at four hospitals in Southern California using a novel survey tool. We validated the survey through a seven-step process that included expert content review, as well as cognitive interviews and pilot testing. We included attendings, fellows, advanced practice providers, and surgical residents who were assigned inpatient clinical duties at their respective sites. We included general and subspecialty surgeons. We excluded pediatric residents due to the model of care at the largest of the four hospitals surveyed. The survey was disseminated electronically to 115 hospitalists and 109 surgeons and was open for eight weeks. We collected data regarding the perceived frequency of communication for 37 handoff elements and how essential each element was for an ideal handoff. For each handoff element, we used five-point Likert scales of communication frequency and essentialness. Participants also identified perceived and preferred handoff timing. Descriptive statistics were calculated.
Results: A total of 70 hospitalists (61%) and 27 surgeons (25%) responded to the survey. Regarding handoff element essentialness, among all respondents for all elements, the mean rating was 4.07 ± 0.52. Scores of 4 and 5 denoted elements rated very essential and extremely essential, respectively. Eleven handoff elements were rated a mean of 4.5 or greater by either hospitalists or surgeons, or by both (Table 1). On average, surgeons perceived that all 37 handoff elements were mentioned more frequently than perceived by hospitalists. Fifty-five percent of hospitalists preferred handoff take place immediately prior to the patient leaving the PACU compared to 28% of surgeons. In contrast, 60% of surgeons preferred handoff take place immediately post-operatively compared to 37% of hospitalists. Surgeon respondents were more likely to have been in practice longer and participate in post-operative handoff less recently and less frequently than hospitalists.
Conclusions: We identified eleven clinical elements that pediatric hospitalists and surgeons rate as most essential to include in handoff. We also identified discrepancies in perceived communication frequency and preferred handoff timing. These findings can facilitate the development of a standardized handoff tool and guide the optimal timing for its use toward post-operative communication between surgeons and hospitalists on acute care units, which may decrease communication errors and improve patient outcomes.