title: Who to handover: a case-control study of a novel scoring system to prioritise handover of internal medicine inpatients.
abstract: BACKGROUND
  Handover of patients between care providers is a critical event in patient care. There is, however, little evidence to guide the handover process, including determining which patients to handover.
  
  
  OBJECTIVE
  Compare the ability of gestalt-based handover with two structured scores, the modified early warning score (MEWS) and our novel iHAND clinical decision support system, to predict which patients will be assessed by a physician overnight.
  
  
  METHODS
  This case-control study included 90 inpatients, comprising 32 patients assessed overnight (cases) and 58 patients not assessed overnight (controls) at a teaching hospital in British Columbia, Canada (May 2012). Gestalt, MEWS and iHAND scores were analysed against patients seen overnight using logistic regression and receiver-operating characteristic (ROC) curves.
  
  
  RESULTS
  Neither current gestalt-based handover practice (odds ratio (OR) 1.50, 95% CI 0.89 to 3.83) nor MEWS (OR 0.96, 95% CI 0.75 to 1.24, area under the ROC curve (AUC) 0.61, 95% CI 0.49 to 0.73) were significantly associated with need to be seen overnight. The iHAND score was associated with need to be seen (OR 1.93, 95% CI 1.24 to 3.02, AUC 0.70, 95% CI 0.60 to 0.81).
  
  
  CONCLUSIONS
  The iHAND score had moderate ability to predict which patients required assessment overnight, while MEWS score and current gestalt approach correlated poorly, suggesting the iHAND score may help prioritisation of patients likely to be seen overnight for handover.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jesse
authors.identifier: http://orcid.org/0000-0002-0017-046X
authors.initials: J
authors.lastname: Bittman
authors.affiliation: Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Penny
authors.initials: P
authors.lastname: Tam
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Little
authors.affiliation: Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Khan
mesh_terms: D000368:Aged; D001955:British Columbia; D016022:Case-Control Studies; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff; D011237:Predictive Value of Tests; D018570:Risk Assessment
keywords: INTERNAL MEDICINE; MEDICAL EDUCATION & TRAINING