Residents’ and Attending Physicians’ Handoffs: A Systematic Review of the Literature

Riesenberg, Lee Ann; Leitzsch, Jessica; Massucci, Jaime L.; Jaeger, Joseph; Rosenfeld, Joel C.; Patow, Carl A.; Padmore, Jamie S.; Karpovich, Kelly P.

doi:10.1097/acm.0b013e3181bf51a6

Cited by 312 publications

(209 citation statements)

References 61 publications

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“…23,222 However, the concept of 'team' in healthcare is rapidly evolving to include a greater emphasis on interprofessional collaboration, 223 as well as new team structures. With the advent of restricted duty hours, 224 and frequent hand-offs, 29,30 team members are often working in shifts [225][226][227] and are also becoming dispersed geographically. The telemedicine intensive care unit is an example in which intensivists and nurses use telemetry and electronic medical records to provide care to patients hospitalized remotely.…”

Section: Discussionmentioning

confidence: 99%

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Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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OBJECTIVE: Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES: We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY: Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS:Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS: Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS: Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS:There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes. 3,4 Recognizing this, the Institute of Medicine, the Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), and others have made teamwork a top priority in their recommendations for improving healthcare. [5][6][7][8][9] Teamwork is also prominently positioned within the American Board of Internal Medicine (ABIM) requirements for maintenance of certification for internists, 10 as well as the Accreditation Council for Graduate Medical Education's core competencies, 11 milestones, 12 and medical student competencies. 13 As such, every physician at the undergraduate, graduate, and continuing professional level must demonstrate competency in teamwork.While there is broad agreement on the imperative to improve teamwork, there is littl...

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Section: Discussionmentioning

confidence: 99%

“…Studies of patient hand-over were excluded since recent reviews on this topic have been published. [29][30][31] Title and Abstract ReviewThe search yielded 12,922 citations (Fig. 1).…”

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Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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“…2,3 Recognizing such findings, a growing body of literature addresses handoff techniques for learners. [4][5][6][7] Vidyarthi described the handoff process as ''traditionally informal, unstructured, and idiosyncratic,'' 4 and many believe efforts to formalize and structure this process are important for patient safety. 8 Standardized handoff forms have improved accuracy of information.…”

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confidence: 99%

Gaining efficiency and satisfaction in the handoff process

Burton

Kashiwagi

Kirkland

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians‐in‐training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants.METHODS:An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in‐room conversations), and poor communication. The team restructured the process and observed post‐intervention behavior at 15 and 90 days. A participant‐provider survey was conducted before and after the intervention regarding wasted time, total time‐in‐report, and satisfaction with the process.RESULTS:Pre‐intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post‐intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre‐intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post‐intervention (P < 0.0001).CONCLUSIONS:This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non‐clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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“…Despite widespread awareness of the negative consequences of poor communication in handoffs and transitions of care, little research has identified best practices. 7,48,49 Authors such as Hilligoss and Cohen 50 and Horowitz and colleagues 51 suggest that education for effective handoffs incorporate direct observation and feedback or handoff behaviors, use of reflective practice as a way to inculcate vigilance, and attention to differences in handoff types (for example, within-unit handoffs [between trainees who are largely known to one another] and betweenunit transfers of care [between trainees or attending physicians who are strangers to one another]). We are developing a handover tool for residents and attending physicians 7 have reviewed the literature on handoffs in a number of high reliability industries and concluded that faceto-face handoffs have the highest accuracy and reliability.…”

Section: Discussionmentioning

confidence: 99%

Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic

Rattray

Sico

Cox

et al. 2017

The Joint Commission Journal on Quality and Patient Safety

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Background: Transitions of care from specialty and acute settings to primary care abound. Compared to the continuity in end-of-shift handoffs, care transitions involve provider communication between practices and facilities with their own cultures and bureaucracies. Using the transition from acute care to outpatient primary care for stroke/transient ischemic attack (TIA) patients as a case study, this qualitative research explored communication practices and institutional arrangements among clinical providers responsible for longitudinal management of hypertension.

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Residents’ and Attending Physicians’ Handoffs: A Systematic Review of the Literature

Cited by 312 publications

References 61 publications

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Gaining efficiency and satisfaction in the handoff process

Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic

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