Recently adopted resident work hour restrictions from the Accreditation Council for Graduate Medical Education have encouraged separate day and night patient care models. Dividing day and night responsibilities results in “admission handoffs,” in which ongoing inpatient care is handled by a different physician than the admitting physician. Inexperience with crosscover or service transitions has been associated with provider discomfort and worse outcomes. Many hospitalist programs utilize separate day and night staffing models. Data are lacking regarding observed adverse event rate and comfort level of physicians regarding inpatients received via admission handoff. We evaluated hospitalist and resident perceptions regarding admission handoffs.
Internal medicine house officers and attending hospitalists who provide direct inpatient care at our tertiary care academic hospital were surveyed between April 2011 and June 2011 to determine comfort level with admission handoffs, training exposure, observed rate of adverse events, processingtime and decisionmaking related to admission handoffs.
One hundred and ninetyeight physicians (44 hospitalists, 154 residents) were included in the survey. Ninetyeight (49.5%) physicians (18 hospitalists, 80 residents) responded. Eightyone percent of hospitalists had 11 or more admission handoffs in the past 4 weeks, compared with 37% of residents (p = 0.001). Using a 10point Likert scale (10 being highest comfort rating), both residents (5.7 vs 8.6, p < 0.00001) and hospitalists (6.9 vs 8.7, p < 0.0004) were significantly less comfortable managing patients admitted by another physician compared with patients that they admitted. Hospitalists were more comfortable than residents managing patients admitted by other physicians (6.9 vs 5.7, p = 0.003). Fiftysix percent of hospitalists and 36% of residents had not received formal training in giving admission handoffs (p = 0.13). Thirtyeight percent of hospitalists and 29% of residents could recall an adverse event related to admission handoffs (p = 0.50). Thirtyone percent of hospitalists and 56% of residents felt they did not have enough time to process handoff information for 40% or more of admission handoffs (p = 0.08). Sixtythree percent of hospitalists and 73% of residents were sometimes or often uncertain about management decisions due to lack of information (p = 0.47).
Hospitalists are more comfortable than residents with admission handoffs, but all surveyed physicians were less comfortable with patients that another physician admitted than patients they themselves admitted. Insufficient and hurried admission handoffs were the norm, and adverse events attributed to a poor admission handoff were frequent. Experience and admission handoff volume may account for some of the differences in comfort between hospitalists and residents. Current formal training techniques do not clearly alleviate discomfort. Further study is needed to identify both the true frequency of adverse events and interventions to improve the care of patients admitted in this fashion.
To cite this abstract:Odden A, Viglianti E, Kuhn L, Houchens N, Chang R. Admission Handoffs: A Novel Transition of Care That Leads to Discomfort with Patient Management. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97559. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/admission-handoffs-a-novel-transition-of-care-that-leads-to-discomfort-with-patient-management/. Accessed April 21, 2019.