Understanding communication during hospitalist service changes: a mixed methods study.
BACKGROUND
Little data exist to inform hospitalist communication during service changes.


OBJECTIVE
To characterize hospitalist handoffs during service changes.


METHODS
Serial survey study.


METHODS
Single academic medical center.


METHODS
From May to December 2007, 60 service changes among 17 hospitalists on a nonteaching service were targeted for evaluation using an anonymous 18-item survey that was completed by hospitalists within 48 hours of assuming care for patients. Survey items assessed completeness of handoff communication, certainty of patient care plans, missed information, time spent recovering information, and near misses/adverse events due to incomplete handoffs. The association between completeness of communication and handoff outcomes was examined. Narrative comments were analyzed qualitatively.


RESULTS
Ninety-three percent (56/60) of surveys were returned. All 17 hospitalists participated. Thirteen percent of respondents reported incomplete handoffs and 18% were uncertain of care plan on transition day. At least 1 near miss, attributable to incomplete communication was reported by 16%. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about patient care plans on the transition day (71% incomplete vs. 10% complete, P < 0.01), discovery of missing information (71% incomplete vs. 24% complete, P = 0.01), near misses/adverse events (57% incomplete vs. 10% complete, P < 0.01), and more time resolving issues arising from missed information (71% incomplete vs. 22% complete, P < 0.01). Qualitative comments suggest the need for a more systematic, focused, team-based, and patient-centered handoff model.


CONCLUSIONS
Incomplete handoffs during service changes are associated with uncertainty and potential patient harm. Suggestions to improve the completeness of hospitalist service change communications are offered.
Hinami
Keiki
K
Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA. khinami@nmh.org
Farnan
Jeanne M
JM
Meltzer
David O
DO
Arora
Vineet M
VM
D000046:Academic Medical Centers / Q000458:organization & administration*; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D020445:Hospitalists; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D013997:Time Factors