H. Hasan1, P. Barker1, R. Treat3, J. Peschman1, M. Mohorek1, P. Redlich2, T. Webb1 1Medical College Of Wisconsin,Division Of Education/ Department Of Surgery,Milwaukee, WI, USA 2Clement J Zablocki Veterans Affairs Medical Center,Department Of Surgery,Milwaukee, WI, USA 3Medical College Of Wisconsin,Department Of Emergency Medicine,Milwaukee, WI, USA
Introduction: The implementation of resident duty hour restrictions has led to increased patient care handoffs and thus more opportunities for errors during transitions of care. Much of the current handoff literature is empiric, and a recent editorial in the Journal of GME recommended studying handoffs within an established framework.
Methods: This is a prospective, single institution study evaluating the process of patient handoffs in the context of a published communication framework. IRB approval and written consent of participants were obtained. Evaluation tools for the source, recevier and observer were developed to identify factors that impair the handoff process. A subset of handoffs included two observers and/or two receivers to assess rater consistency. Data analysis was generated with IBM® SPSS® 21.0 with Pearson/Spearman correlations and multivariate linear regressions. Rater consistency was assessed with intraclass correlations (ICC 2,1).
Results: 126 handoffs were observed. Evaluations were completed by one observer (N=126), two observers (N=23), two receivers (N=39), one receiver (N=82), and one source (N=78). An average team handoff included 9.2(+4.6) patients, lasted 9.1(+5.4) minutes and had 4.7(+3.4) distractions recorded by the observer. Extraneous staff entering/exiting the room was the most common distraction, occuring 1.5(+1.9) times per handoff. The source and receivers recognized distractions in >67% of handoffs, with the most common internal and external distractions being fatigue (60% of handoffs) and extraneous staff entering/exiting the room (31%), respectively. Teams with more patients spent less time per individual patient handoff (r= -0.298;p=0.001). Statistically significant intraclass correlations (p≤.05) were moderate between observers (r≥0.4), but not receivers (r<0.4). ICC values between different types of raters were inconsistent (p>.05). The quality of the handoff process was predicted by presence of electronic devices (Beta=-0.565;p=0.005), number of teaching discussions (Beta=-0.417;p=0.048), resident hierarchy (Beta=-0.309;p=0.002), and the receiver’s working relationship with the source (Beta=0.829;p<0.001).
Conclusion: Studying the handoff process within an established framework highlights factors that impair communication. Internal and external distractions are common during handoffs, and along with the working relationship between the source and receiver, impact the quality of the handoff process. This information allows further study and targeted interventions of the handoff process to improve overall handoff effectiveness and patient safety.