Handoffs have received increased scrutiny due to changes in ACGME guidelines for resident work hours. Studies have shown that a combination of standardized written format and face‐to‐face modalities are ideal for facilitating the handoff process. Few studies have used validated tools to critically evaluate face‐to‐face and written handoff systems after their integration in inpatient settings. Our objective was to assess the quality of the face‐to‐face and written handoffs on inpatient Internal Medicine teaching services at University of Kansas Hospital.
Using the Handoff CEX tool, we evaluated 42 face‐to‐face and 56 written handoffs. Face‐to‐face handoffs were observed between residents and interns during two day‐to‐night shift changes. We conducted a review of 56 written handoffs provided by an Internal Medicine attending. Both auto‐populated and manual entry aspects of handoffs were assessed. One student scored each handoff after measures were taken to ensure inter‐rater reliability.
In face‐to‐face handoffs, average total score was 6.42 (3.86‐8.86). Interns scored lower than residents in organization (p=0.0003), content (p=0.0043), clinical judgment (p=0.0056), and overall competence (p=<0.0001). In written handoffs, 98% had a problem summary statement, 57% had 3+ problems with management. 75% had complete “To Do” list and 71% complete anticipatory guidance. Average score was 17.75 (12‐20).
Using a validated tool, we observed good performance in both face‐to‐face and written handoffs, but also identified opportunities for improvement. Based on our results, we have proposed resident education in the structure of both face‐to‐face and written handoffs and modification of the auto‐population feature to address identified shortcomings. In the future this study could be expanded through analyzing the accuracy of handoffs.
To cite this abstract:Abebe A, Pal A, Ramaswamy M, Niemann N, Poull L, Schwerdtfager J, Trusty W. Quality Assessment of Resident Handoffs in Transitions of Care. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 97. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/quality-assessment-of-resident-handoffs-in-transitions-of-care/. Accessed March 20, 2019.