Background Handoffs are ubiquitous to Hospital Medicine and considered a vulnerable time for patient safety. Purpose To develop recommendations for hospitalist handoffs during shift change and service change. Data Sources PubMed (through January 2007), AHRQ Patient Safety Network, white papers, and hand search of article bibliographies. Study Selection Controlled studies evaluating interventions to improve in-hospital handoffs (n = 10). Data Extraction Studies were abstracted for design, setting, target, outcomes (including patient, staff, or system level outcomes), and relevance to hospitalists. Data Synthesis Although there were no studies of hospitalist handoffs, the existing literature from related disciplines and expert opinion support the use of a verbal handoff supplemented with written documentation in a structured format or technology solution. Technology solutions were associated with a reduction in preventable adverse events, improved satisfaction with handoff quality, and improved provider identification. Nursing studies demonstrate that supplementing verbal exchange with a written medium leads to improved retention of information. White papers characterized effective verbal exchange as focusing on ill patients and actions required, with time for questions and minimal interruptions. In addition, content should be updated daily to ensure communication of the latest clinical information. Using this literature, recommendations for hospitalist handoffs are presented with corresponding levels of evidence. Recommendations were reviewed by hospitalists at the Society of Hospital Medicine (SHM) Annual Meeting and by an interdisciplinary team of expert consultants and were endorsed by the SHM governing Board. Conclusions The systematic review and resulting recommendations provide hospitalists a starting point from which to improve in-hospital handoffs.

BACKGROUND: Over the past decade, handheld computers (or personal digital assistants [PDAs]) have become a popular tool among medical trainees and physicians. Few comprehensive reviews of PDA use in medicine have been published. OBJECTIVE: We systematically reviewed the literature to (1) describe medical trainees' use of PDAs for education or patient care, (2) catalog popular software applications, and (3) evaluate the impact of PDA use on patient care. DATA SOURCES: MEDLINE (1993 to 2004), medical education‐related conference proceedings, and hand search of article bibliographies. REVIEW METHODS: We identified articles and abstracts that described the use of PDAs in medical education by trainees or educators. Reports presenting a qualitative or quantitative evaluation were included. RESULTS: Sixty‐seven studies met inclusion criteria. Approximately 60% to 70% of medical students and residents use PDAs for educational purposes or patient care. Satisfaction was generally high and correlated with the level of handheld computer experience. Most of the studies included described PDA use for patient tracking and documentation. By contrast, trainees rated medical textbooks, medication references, and medical calculators as the most useful applications. Only 1 randomized trial with educational outcomes was found, demonstrating improved learning and application of evidence‐based medicine with use of PDA‐based decision support software. No articles reported the impact of PDA use on patient outcomes. CONCLUSION: Most medical trainees find handhelds useful in their medical education and patient care. Further studies are needed to evaluate how PDAs impact learning and clinical outcomes.

Traditional hospital wards are not specifically designed as effective clinical microsystems. The feasibility and sustainability of doing so are unclear, as are the possible outcomes. To reorganize a traditional hospital ward with the traits of an effective clinical microsystem, we designed it to have 4 specific features: (1) unit‐based teams, (2) structured interdisciplinary bedside rounds, (3) unit‐level performance reporting, and (4) unit‐level nurse and physician coleadership. We called this type of unit an accountable care unit (ACU). In this narrative article, we describe our experience implementing each feature of the ACU. Our aim was to introduce a progressive approach to hospital care and training. Journal of Hospital Medicine 2015;10:36–40. © 2014 Society of Hospital Medicine

Nerve growth factor (NGF) is the best understood of a class of trophic proteins that are important for the survival of neurons and the elaboration of their characteristic processes. Here we demonstrate that RINm5F, a rat insulinoma cell line representing an early stage in pancreatic beta cell differentiation, expresses both the Trk and p75 NGF receptors and responds to NGF by extending neurite-like (neuroframentcontaining) processes.

Standardisation of information transmitted during patient handovers through the use of a structured, web-based application led to consistent transfer of vital patient information and was associated with improved resident confidence and fewer perceived near-miss events on call.