Compliance with the 2011 Accreditation Council for Graduate Medical Education work hour restrictions has led to increased numbers of hand‐overs. As a result, there is a renewed focus to maximize patient safety in this era of increased hand‐overs. Several elements have been identified as necessary for safe hand‐overs including, 1) face‐to‐face communication, 2) opportunities to ask questions, 3) private hand‐over locations, 4) accompanying written documentation, 5) non‐distracting environments, and 6) minimization of interruptions. In order to explore areas of strengths and weaknesses in current hand‐over processes, we examined intern‐to‐intern hand‐overs at two large academic, tertiary care medical centers in Baltimore, Maryland.
We conducted a prospective, observational study of medicine interns at two large academic medical centers in January, 2012. Trained observers recorded data on intern‐to‐intern hand‐overs. The primary outcome included the six key elements of the hand‐over process: face‐to‐face communication, questions asked by the recipient, occurring in non‐distracting and private locations, featuring written documentation, and free from interruptions. We recruited a convenience sample of 29 interns rotating on general medicine services on a variety of day and night shifts during all days of the week. We trained 22 undergraduate students to observe the interns, record the six hand‐over elements and upload data to a central repository using the iPod Touch™ “Spreadsheet” application. We determined the percentage of hand‐overs that included each of the six primary outcomes as a dichotomous variable at both sites and analyzed data between sites with Chi‐Square tests and multi‐level regression analysis adjusted for clustering at the intern and observer levels.
We observed and collected data on 212 discrete intern‐to‐intern hand‐overs (109 at site 1 and 103 at site 2). Patient hand‐overs almost universally occurred face‐to‐face (211/212 = 99.5%), in private locations (193/212 = 91%) and with accompanying written documentation (203/212 = 95.8%). The majority of hand‐overs included questions posed by the receiving intern (180/211 = 85.3%). However, 12.3% (26/212) of hand‐overs occurred in a distracting location and 41.3% (86/208) were interrupted. Hand‐overs were more likely to be interrupted at site 1 than site 2 (site 1 – 53/108 = 49.1%; site 2‐ 33/100 = 33%, p=0.03). Performance of the other behaviors did not vary significantly by site.
Changes to resident work hours in 2011 led to increased numbers of hand‐overs and potential for miscommunication and patient harm. The 2011 ACGME common program requirements mandate that residents are not only competent in the hand‐over process but also that institutions ensure effective, structured hand‐over processes. During this study, residents at both programs conducted hand‐overs face‐to‐face and with written documentation almost universally. Question‐asking behavior occurred frequently. However, residents were frequently interrupted (41.3%) and conducted hand‐overs in distracting locations (12.3%), indicating environmental barriers to effective handovers remain to be overcome. Optimizing hand‐over environments to optimize transitions of care will require collaborative engagement from both residency programs and institutions.
To cite this abstract:Habicht R, Block L, Oliver N, Silva K, Feldman L. Assessing Intern Hand‐Over Processes in an Era of Increased Transitions of Care. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 156. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/assessing-intern-handover-processes-in-an-era-of-increased-transitions-of-care/. Accessed April 25, 2019.