BACKGROUND:Governmental agencies in the United Kingdom and Scotland have recently instituted guidelines banning physicians' white coats and the wearing of long‐sleeved garments to decrease nosocomial transmission of bacteria.OBJECTIVE:Our aim was to compare the degree of bacterial and methicillin‐resistant Staphylococcus aureus contamination of physicians' white coats with that of newly laundered, standardized short‐sleeved uniforms after an 8‐hour workday and to determine the rate at which bacterial contamination of the uniform ensued.DESIGN:The design was a prospective, randomized controlled trial.SETTING:The setting was a university‐affiliated public safety‐net hospital.PARTICIPANTS:One hundred residents and hospitalists on an internal medicine service participated.INTERVENTION:Subjects wore either a physician's white coat or a newly laundered short‐sleeved uniform.MEASUREMENTS:Bacterial colony count and the frequency with which methicillin‐resistant Staphylococcus aureus was cultured from both garments over time were measured.RESULTS:No statistically significant differences were found in bacterial or methicillin‐resistant Staphylococcus aureus contamination of physicians' white coats compared with newly laundered short‐sleeved uniforms or in contamination of the skin at the wrists of physicians wearing either garment. Colony counts of newly laundered uniforms were essentially zero, but after 3 hours of wear they were nearly 50% of those counted at 8 hours.CONCLUSIONS:Bacterial contamination occurs within hours after donning newly laundered short‐sleeved uniforms. After 8 hours of wear, no difference was observed in the degree of contamination of uniforms versus infrequently laundered white coats. Our data do not support discarding long‐sleeved white coats for short‐sleeved uniforms that are changed on a daily basis. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

BACKGROUND Real‐time feedback about patients' perceptions of the quality of the care they are receiving could provide physicians the opportunity to address concerns and improve these perceptions as they occur, but physicians rarely if ever receive feedback from patients in real time. OBJECTIVE To evaluate if real‐time patient feedback to physicians improves patient experience. DESIGN Prospective, randomized, quality‐improvement initiative. SETTING University‐affiliated, public safety net hospital. PARTICIPANTS Patients and hospitalist physicians on general internal medicine units. INTERVENTION Real‐time daily patient feedback to providers along with provider coaching and revisits of patients not reporting optimal satisfaction with their care. MEASUREMENTS Patient experience scores on 3 provider‐specific questions from daily surveys on all patients and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and percentiles on randomly selected patients. RESULTS Changes in HCAHPS percentile ranks were substantial (communication from doctors: 60th percentile versus 39th, courtesy and respect of doctors: 88th percentile versus 23rd, doctors listening carefully to patients: 95th percentile versus 57th, and overall hospital rating: 87th percentile versus 6th (P = 0.02 for overall differences in percentiles), but we found no statistically significant difference in the top box proportions for the daily surveys or the HCAHPS survey. The median [interquartile range] top box score for the overall hospital rating question on the HCAHPS survey was higher in the intervention group than in the control group (10 [9, 10] vs 9 [8, 10], P = 0.04). CONCLUSIONS Real‐time feedback, followed by coaching and patient revisits, seem to improve patient experience. Journal of Hospital Medicine 2016;11:251–256. © 2016 Society of Hospital Medicine

The structured handoff program improved the participating interns' perceptions of their knowledge of the handoff process and their ability to transfer the care of their patients effectively. The formal program for teaching handoffs, that included attendings' supervision of the process, was well received.