Background The increasing fragmentation of healthcare has resulted in more patient handoffs. Many professional groups, including the Accreditation Council on Graduate Medical Education and the Society of Hospital Medicine, have made recommendations for safe and effective handoffs. Despite the two-way nature of handoff communication, the focus of these efforts has largely been on the person giving information. Objective To observe and characterize the listening behaviors of handoff receivers during hospitalist handoffs. Design Prospective observational study of shift change and service change handoffs on a non-teaching hospitalist service at a single academic tertiary care institution. Measurements The “HEAR Checklist”, a novel tool created based on review of effective listening behaviors, was used by third party observers to characterize active and passive listening behaviors and interruptions during handoffs. Results In 48 handoffs (25 shift change, 23 service change), active listening behaviors (e.g. read-back (17%), note-taking (23%), and reading own copy of the written signout (27%)) occurred less frequently than passive listening behaviors (e.g. affirmatory statements (56%) nodding (50%) and eye contact (58%)) (p<0.01). Read-back occurred only 8 times (17%). In 11 handoffs (23%) receivers took notes. Almost all (98%) handoffs were interrupted at least once, most often by side conversations, pagers going off, or clinicians arriving. Handoffs with more patients, such as service change, were associated with more interruptions (r= 0.46, p<0.01). Conclusions Using the “HEAR Checklist”, we can characterize hospitalist handoff listening behaviors. While passive listening behaviors are common, active listening behaviors that promote memory retention are rare. Handoffs are often interrupted, most commonly by side conversations. Future handoff improvement efforts should focus on augmenting listening and minimizing interruptions.

BACKGROUND Although peer evaluation can be used to evaluate in‐hospital handoffs, few studies have described using this strategy. OBJECTIVE Our objective was to assess feasibility of an online peer handoff evaluation and characterize performance over time among medical interns. DESIGN The design was a prospective cohort study. PATIENTS Subjects were medical interns from residency program rotating at 2 teaching hospitals. MEASUREMENTS Measurements were performance on an end‐of‐rotation evaluation of giving and receiving handoffs. RESULTS From July 2009 to March 2010, 31 interns completed 60% (172/288) of peer evaluations. Ratings were high across domains (mean, 8.3–8.6). In multivariate regression controlling for evaluator and evaluatee, statistically significant improvements over time were observed for 4 items compared to the first 3 months of the year: 1) communication skills (season 2, +0.34 [95% confidence interval (CI), 0.08‐0.60], P = 0.009); 2) listening behavior (season 2, +0.29 [95% CI, 0.04‐0.55], P = 0.025); 3) accepting professional responsibility (season 3, +0.37 [95% CI, 0.08‐0.65], P = 0.012); and 4) accessing the system (season 2, +0.21 [95% CI, 0.03‐0.39], P = 0.023). Ratings were also significantly lower when interns were postcall in written sign‐out quality (8.21 vs 8.39, P = 0.008) and accepting feedback (8.25 vs 8.42, P = 0.006). Ratings from a community hospital rotation, with a lower census than the teaching hospital, were significantly higher for overall performance and 7 of 12 domains (P < 0.05 for all). Significant evaluator effects were observed. CONCLUSIONS Although there is evidence of leniency, peer evaluation of handoffs demonstrate increases over time and associations with workload such as postcall status. This suggests the importance of examining how workload impacts handoffs in the future. Journal of Hospital Medicine 2013;8:132–136. © 2012 Society of Hospital Medicine

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