title: A theoretical framework and competency-based approach to improving handoffs.
abstract: BACKGROUND
  Once characterised by remarkable continuity of care by a familiar doctor, patient care today is delivered by multiple physicians with varying degrees of knowledge of the patient. Yet, few trainees learn the potential risks of these transitions and the strategies to improve patient care during handoffs. Little is known regarding the mechanisms by which handoffs affect patient care.
  
  
  RESULTS
  Building on theoretical constructs from the social sciences and illustrated with a case study of the implementation of a night float service for the inpatient general medicine services at the University of Chicago, a conceptual framework is proposed to describe how handoffs affect both patients and physicians.
  
  
  CONCLUSIONS
  Using this conceptual framework, recommendations are made for formal education based on the core competencies of communication and professionalism. Opportunities to educate trainees in acquiring these skills are described in the context of handoffs of patient care.
authors.affiliation: V M Arora, University of Chicago, 5841 S. Maryland Ave., MC 2007, AMB W216, Chicago, IL 60637, USA. varora@medicine.bsd.uchicago.edu
authors.forename: V M
authors.initials: VM
authors.lastname: Arora
authors.forename: J K
authors.initials: JK
authors.lastname: Johnson
authors.forename: D O
authors.initials: DO
authors.lastname: Meltzer
authors.forename: H J
authors.initials: HJ
authors.lastname: Humphrey
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D002641:Chicago; D003142:Communication; D003162:Competency-Based Education / Q000379:methods*; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D004282:Documentation / Q000379:methods* / Q000592:standards; D017598:Efficiency, Organizational; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D017146:Models, Organizational; D019982:Organizational Case Studies; D017064:Process Assessment, Health Care