Patient Info Lost In the Shift Shuffle

Multiple shift changes and patient handovers are leading to a decrease in the amount and quality of information conveyed between residents, according to a study of 89 internal medicine residents at the University of Virginia, Charlottesville. The study analyzed the current process of patient handovers, as well as resident opinions about the process.

Residents surveyed said information about laboratory test results (87%) and patient medications (84%) was frequently inaccurate when passed on to the next resident on shift. Only 24% of the time did residents report no major errors or omissions on a sign-out form. In addition, even less information was conveyed during the night shift.

For example, lab test results were discussed 24% less often than during the day shift, as well as treatment plans (21% less often), and active problems (10% less often). In addition, 40% of residents said they didn’t expect to have to make any decisions about patient care during a handoff period (J. Gen. Intern. Med. 2011 [doi:10.1007/s11606-011-1885-4]).

In the study, led by Dr. Adam Helms, the authors wrote that the degradation of information passed between residents leaves the patient to suffer the consequences.

"Inadequate handoff of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during crossover periods and has been associated with adverse events," wrote Dr. Helms and his colleagues.

Residents felt there was no consensus on how patient handovers should be carried out and that the lack of consensus is a result of a lack of direction, the authors observed.

The researchers found great value in using an appreciative-inquiry approach, identifying common attributes to improve the efficiency and organization of sign-out. They defined appreciative inquiry as "a highly effective change methodology that focuses on finding what is working in a system and using that as a basis for improvement."

"A key finding of the appreciative-inquiry group was that both written and verbal sign-out should be concise and organized in a systematic way by all residents," the authors wrote.

"Most residency programs do not have curriculum devoted to the sign-out process, and there is currently little prospective evidence supporting specific sign-out content or process," the authors wrote.

Residency programs have been increasingly faced with handling patient handoffs since the Accreditation Council for Graduate Medical Education first instituted program requirements limiting residents to an 80-hour work week in 2003. While Dr. Helms offered few details, researchers wrote that as a result of their analysis, they’ve developed an educational curriculum, as well as an electronic database to support the sign-out process at the university. The authors also encouraged other teaching institutions to do the same.

"Initiating an educational curriculum for sign-out at teaching hospitals is critical not only for establishing a standardized process for sign-out, but for creating a culture of patients’ ownership among cross-covering physicians," they wrote.

The study was sponsored in part by a grant from the National Library of Medicine, the University of Virginia’s Graduate Medical Education Office, and the University of Virginia’s Institute of Quality and Patient Safety. One of the study authors is an investigator on a Bristol-Myers Squibb–sponsored diabetes study.

Multiple shift changes and patient handovers are leading to a decrease in the amount and quality of information conveyed between residents, according to a study of 89 internal medicine residents at the University of Virginia, Charlottesville. The study analyzed the current process of patient handovers, as well as resident opinions about the process.

Residents surveyed said information about laboratory test results (87%) and patient medications (84%) was frequently inaccurate when passed on to the next resident on shift. Only 24% of the time did residents report no major errors or omissions on a sign-out form. In addition, even less information was conveyed during the night shift.

For example, lab test results were discussed 24% less often than during the day shift, as well as treatment plans (21% less often), and active problems (10% less often). In addition, 40% of residents said they didn’t expect to have to make any decisions about patient care during a handoff period (J. Gen. Intern. Med. 2011 [doi:10.1007/s11606-011-1885-4]).

In the study, led by Dr. Adam Helms, the authors wrote that the degradation of information passed between residents leaves the patient to suffer the consequences.

"Inadequate handoff of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during crossover periods and has been associated with adverse events," wrote Dr. Helms and his colleagues.

Residents felt there was no consensus on how patient handovers should be carried out and that the lack of consensus is a result of a lack of direction, the authors observed.

The researchers found great value in using an appreciative-inquiry approach, identifying common attributes to improve the efficiency and organization of sign-out. They defined appreciative inquiry as "a highly effective change methodology that focuses on finding what is working in a system and using that as a basis for improvement."

"A key finding of the appreciative-inquiry group was that both written and verbal sign-out should be concise and organized in a systematic way by all residents," the authors wrote.

"Most residency programs do not have curriculum devoted to the sign-out process, and there is currently little prospective evidence supporting specific sign-out content or process," the authors wrote.

Residency programs have been increasingly faced with handling patient handoffs since the Accreditation Council for Graduate Medical Education first instituted program requirements limiting residents to an 80-hour work week in 2003. While Dr. Helms offered few details, researchers wrote that as a result of their analysis, they’ve developed an educational curriculum, as well as an electronic database to support the sign-out process at the university. The authors also encouraged other teaching institutions to do the same.

"Initiating an educational curriculum for sign-out at teaching hospitals is critical not only for establishing a standardized process for sign-out, but for creating a culture of patients’ ownership among cross-covering physicians," they wrote.

The study was sponsored in part by a grant from the National Library of Medicine, the University of Virginia’s Graduate Medical Education Office, and the University of Virginia’s Institute of Quality and Patient Safety. One of the study authors is an investigator on a Bristol-Myers Squibb–sponsored diabetes study.

Multiple shift changes and patient handovers are leading to a decrease in the amount and quality of information conveyed between residents, according to a study of 89 internal medicine residents at the University of Virginia, Charlottesville. The study analyzed the current process of patient handovers, as well as resident opinions about the process.

Residents surveyed said information about laboratory test results (87%) and patient medications (84%) was frequently inaccurate when passed on to the next resident on shift. Only 24% of the time did residents report no major errors or omissions on a sign-out form. In addition, even less information was conveyed during the night shift.

For example, lab test results were discussed 24% less often than during the day shift, as well as treatment plans (21% less often), and active problems (10% less often). In addition, 40% of residents said they didn’t expect to have to make any decisions about patient care during a handoff period (J. Gen. Intern. Med. 2011 [doi:10.1007/s11606-011-1885-4]).

In the study, led by Dr. Adam Helms, the authors wrote that the degradation of information passed between residents leaves the patient to suffer the consequences.

"Inadequate handoff of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during crossover periods and has been associated with adverse events," wrote Dr. Helms and his colleagues.

Residents felt there was no consensus on how patient handovers should be carried out and that the lack of consensus is a result of a lack of direction, the authors observed.

The researchers found great value in using an appreciative-inquiry approach, identifying common attributes to improve the efficiency and organization of sign-out. They defined appreciative inquiry as "a highly effective change methodology that focuses on finding what is working in a system and using that as a basis for improvement."

"A key finding of the appreciative-inquiry group was that both written and verbal sign-out should be concise and organized in a systematic way by all residents," the authors wrote.

"Most residency programs do not have curriculum devoted to the sign-out process, and there is currently little prospective evidence supporting specific sign-out content or process," the authors wrote.

Residency programs have been increasingly faced with handling patient handoffs since the Accreditation Council for Graduate Medical Education first instituted program requirements limiting residents to an 80-hour work week in 2003. While Dr. Helms offered few details, researchers wrote that as a result of their analysis, they’ve developed an educational curriculum, as well as an electronic database to support the sign-out process at the university. The authors also encouraged other teaching institutions to do the same.

"Initiating an educational curriculum for sign-out at teaching hospitals is critical not only for establishing a standardized process for sign-out, but for creating a culture of patients’ ownership among cross-covering physicians," they wrote.

The study was sponsored in part by a grant from the National Library of Medicine, the University of Virginia’s Graduate Medical Education Office, and the University of Virginia’s Institute of Quality and Patient Safety. One of the study authors is an investigator on a Bristol-Myers Squibb–sponsored diabetes study.