Utilizing Information Technology to Mitigate the Handoff Risks Caused by Resident Work Hour Restrictions

Abstract

Resident duty hours have been restricted to 80 per week, a limitation thought to increase patient safety by allowing adequate sleep. Yet decreasing work hours increases the number of patient exchanges (so-called "handoff") at the end of shifts. WHERE ARE WE NOW?: A greater frequency of handoff leads to an increased risk of physician error. Information technology can be used to minimize that risk. WHERE DO WE NEED TO GO?: A computer-based expert system can alleviate the problems of data omissions and data overload and minimize asynchrony and asymmetry. A smart system can further prompt departing physicians for information that improves their understanding of the patient's condition. Likewise, such a system can take full advantage of multimedia; generate a study record for self-improvement; and strengthen the interaction between specialists jointly managing patients. HOW DO WE GET THERE?: There are impediments to implementation, notably requirements of the Health Insurance Portability and Accountability Act; medical-legal ramifications, and computer programming costs. Nonetheless, the use of smart systems, not to supplant physicians' rational facilities but to supplement them, promises to mitigate the risks of frequent patient handoff and advance patient care. Thus, a concerted effort to promote such smart systems on the part of the Accreditation Council for Graduate Medical Education (the source of the duty hour restrictions) and the Association of American Medical Colleges (representing medical schools and teaching hospitals) may be effective. We propose that these organizations host a contest for the best smart handoff systems and vigorously promote the winners.

Lost information during the handover of critically injured trauma patients: a mixed-methods study

“…Structure and process consistency are thus paramount to reduce errors and improve outcomes, and standardisation tools such as checklists, within the context of a culture of communication have been proposed for improved outcomes 12 13. This decrease in variability of the information transmitted reduces the amount of information loss,10 facilitates communication within the constraints of an 80 h work week14 and may lead to improved patient outcomes, including reduced mortality 15. Trauma patients, in particular, would benefit from a cohesive handover of information, given their complex presentations 16.…”

Utilization of morning report by acute care surgery teams: results from a qualitative study

“…With the advent of duty hour restrictions, continuity of care has increasingly become a concern in surgical residencies across the country (2-4, 6, 7, 9, 10) . In multiple settings (1, 6) , including general surgery programs (10) , in-person patient hand-offs have been found to be of higher quality for maintaining continuity of care and preventing errors than other modes of communication.…”

“…Duty hour restrictions have challenged training programs to educate their residents in less time while maintaining continuity of care for patients (1-4, 6-9) . While the bulk of patient hand-off literature is generated from internal medicine and emergency medicine departments, the duty hour restrictions have forced surgery departments to consider measures to consolidate trainee education time and expedite patient hand-offs (1, 3, 8, 10-16) .…”

Not the Last Word: Two Patients, Two Operating Rooms, One Surgeon—Does The Math Add Up?

“…For example, the Libby Zion rules were based on the intuitive (and correct) belief that tired physicians may make more errors than their well-rested counterparts. Still, a system of limited duty hours might be worse than a system in which care is given by tired physicians: Frequent patient handoffs [4] may cause more errors than fatigue.…”