Characterising physician listening behaviour during hospitalist handoffs using the HEAR checklist

Abstract

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.

Predicting and Communicating Risk of Clinical Deterioration: An Observational Cohort Study of Internal Medicine Residents

“…[14][15][16][17] Additionally, a recent study of physician handoff practices showed that larger numbers of patient care handoffs were associated with a greater number of interruptions during handoff. 18 These interruptions are associated with increased opportunity for overlooked or omitted patient information, and may explain the greater level of discordance between PGY-3 giver and receiver. 19 Additional potential confounding factors include differences in handoff practices between interns and seniors, as well as the structure of the rotation call schedule.…”

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance

“…Each behavior was chosen after careful review and deliberation of well-publicized work in this area, 16,[19][20][21] previously validated tools to evaluate handoffs such as the Hand-off CEX, 22 and the recommendations for handoffs outlined by the Society of Hospital Medicine. 23 Four of these behaviors were directly taken from the Handoff CEX.…”

“…The fifth behavior, creating a shared space, was added after considering recent work by Greenstein, et al on behaviors that could promote active listening by handoff receivers. 21 During their training, the physicianreceivers were instructed on what it means to demonstrate the observable behavior versus not demonstrate the behavior, and then to mark whether the skill was done (Yes) or not done (No). For each behavior, a high bar was set for completion.…”

The limits of checklists: handoff and narrative thinking

“…Perspective-taking highlights the fact that effective narration entails sensitivity to context and complex, nuanced social interactions that cannot be neatly predefined by a checklist. The failure to consider another's point of view may contribute to ineffective communication during handoff,33 and a few researchers have begun exploring the influence of various perspective-taking practices on these interactions 34 35…”