Exploring Intrateam Handoffs

1Milwaukee VAMC, Milwaukee, WI
2Medical College of Wisconsin, Milwaukee, WI

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 1

Background:

Inpatient continuity is difficult to achieve as house‐staff work‐hour limitations result in more frequent handoffs. Although research on handoffs between teams has been done, little information exists on handoffs within the same team. Our goal was to assess intern perceptions of intrateam handoffs and coverage.

Methods:

We distributed an anonymous cross‐sectional survey to internal medicine interns at our institution. We administered the survey during a required conference. Our inpatient ward teams are composed of an attending physician, a supervising senior resident, and 2 interns. We defined cointern as the other intern on the same team as the respondent. The survey included questions about (1) demographics, (2) situations in which the respondent was covering his/her cointern's patients, and (3) situations when the cointern was covering the respondent's patients. Descriptive statistics were performed.

Results:

Thirty‐four of 44 interns returned the survey (response rate, 77%). Mean age was 28 years (range, 24–37 years). Two‐thirds of respondents were female, and 65% were categorical internal medicine interns. Eighty‐eight percent felt that handoffs to cointerns were different than handoffs to overnight cross‐cover interns. Seventy‐three percent had seen errors in progress notes written on their patients by their cointerns. Interns reported an average of 3.4 days (range, 0–8 days) in their last inpatient ward month when they were asked to cover a cointern's patient who had not been formally handed off to them. When covering for their cointern, 47% reported feeling the same amount of responsibility as for their own patients whereas 38% of interns reported feeling less responsible for their cointerns' patients. While covering a cointern's patients, 42% reported that they missed changes in patients' exams, and 42% forgot to order labs or imaging. Sixty‐one percent reported unexpected family meetings or phone calls. Respondents also noted problems when their cointern covered for them: 70% reported labs or imaging had not been ordered, 33% reported missed lab results, and 30% reported missed consultant recommendations. Seventy‐nine percent of interns felt that patient care was at least sometimes delayed because of incomplete knowledge due to intrateam coverage.

Conclusions:

As house‐staff work hours are restricted and handoffs increase, it is important to understand handoffs between members of the same team. We have identified several problems with patient safety implications that can arise during periods of intrateam coverage. These findings may be relevant to hospitalists practicing without house staff, as most hospitalist handoffs are intrateam handoffs. In addition, hospitalists supervising house staff are uniquely qualified to advise on how to achieve high‐quality intrateam handoffs and how to avoid the pitfalls identified in this survey.

To cite this abstract:

Fletcher K, Martin K. Exploring Intrateam Handoffs. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 1. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/exploring-intrateam-handoffs/. Accessed November 11, 2019.

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