Although shift‐based hospitalist practices involve multiple changes of service, no data exist on how they are conducted. This study aimed to characterize hospitalist handoffs during service change.
Between May and November 2007, 14 hospitalists on a nonteaching service at a U.S. teaching hospital were asked to complete an anonymous 18‐item Likert survey 48 hours after service change regarding completeness of handoff communication, certainty of care plan for patients on the service, time spent getting to know patients, missed information, and near misses or adverse events due to poor service changes. Dichotomized Likert variables were used to summarize service change characteristics. The effects of communication completeness during service change on the ability of hospitalists to pick up new patients and the occurrence of adverse events/near misses were determined using chi‐square tests. Statistical significance was defined as P < .05.
Forty‐nine of 55 surveys (89%) were obtained. The majority (87%) of service changes involved communication on the day prior to the transition. Verbal communication was common (90%), most often by phone (77%) and in person (17%). Forty‐eight percent of handoff communications lasted 6‐15 minutes. Ten percent of hospitalists reported incomplete handoffs, and 18% were uncertain of care plan on transition day. At least 1 bad outcome or near miss resulting from poor communication, was reported by 14%. Time spent on communication was not associated with handoff completeness, certainty of care plan, or adverse events/near misses. Hospitalists who reported incomplete handoffs were more uncertain about patient care plans on the transition day (80% incomplete vs. 11% complete, P < .001). Hospitalists who were uncertain about the care plan on transition day were more likely to report “missed information” that would have helped if included in the handoff (40% uncertain vs. 9% certain, P = .009) and more likely to spend more time (>16 minutes) dealing with issues arising from missing information from the service change (78% uncertain vs. 18% certain, P < .001). Types of missing information included the rationale for nonstandard care and advice from consultants.
Incomplete service changes were associated with uncertainty of patients' plans of care. Uncertainty about care plans was associated with “missed information” and more time dealing with issues arising from it. Interventions to improve hospitalist service changes are indicated.
K. Hinami, University of Chicago, employee; J. Farnan, University of Chicago, employee; V. Arora, University of Chicago, employee.
To cite this abstract:Hinami K, Farnan J, Arora V. Characterizing Communication during Hospitalist Service Changes. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 27. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/characterizing-communication-during-hospitalist-service-changes/. Accessed September 22, 2019.