title: Evaluating handoffs in the context of a communication framework.
abstract: The implementation of mandated restrictions in resident duty hours has led to increased handoffs for patient care and thus more opportunities for errors during transitions of care. Much of the current handoff literature is empiric, with experts recommending the study of handoffs within an established framework.
  
  
  
  A prospective, single-institution study was conducted evaluating the process of handoffs for the care of surgical patients in the context of a published communication framework. Evaluation tools for the source, receiver, and observer were developed to identify factors impacting the handoff process, and inter-rater correlations were assessed. Data analysis was generated with Pearson/Spearman correlations and multivariate linear regressions. Rater consistency was assessed with intraclass correlations.
  
  
  
  A total of 126 handoffs were observed. Evaluations were completed by 1 observer (N = 126), 2 observers (N = 23), 2 receivers (N = 39), 1 receiver (N = 82), and 1 source (N = 78). An average (±standard deviation) service handoff included 9.2 (±4.6) patients, lasted 9.1 (±5.4) minutes, and had 4.7 (±3.4) distractions recorded by the observer. The source and receiver(s) recognized distractions in >67% of handoffs, with the most common internal and external distractions being fatigue (60% of handoffs) and extraneous staff entering/exiting the room (31%), respectively. Teams with more patients spent less time per individual patient handoff (r = -0.298; P = .001). Statistically significant intraclass correlations (P ≤ .05) were moderate between observers (r ≥ 0.4) but not receivers (r < 0.4). Intraclass correlation values between different types of raters were inconsistent (P > .05). The quality of the handoff process was affected negatively by presence of active electronic devices (β = -0.565; P = .005), number of teaching discussions (β = -0.417; P = .048), and a sense of hierarchy between source and receiver (β = -0.309; P = .002).
  
  
  
  Studying the handoff process within an established framework highlights factors that impair communication. Internal and external distractions are common during handoffs and along with the working relationship between the source and receiver impact the quality of the handoff process. This information allows further study and targeted interventions of the handoff process to improve overall effectiveness and patient safety of the handoff.
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors: Hani
authors: H
authors: Hasan
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: fali@mcw.edu.
authors: Fadwa
authors: F
authors: Ali
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors: Paul
authors: P
authors: Barker
authors: Academic Affairs, Medical College of Wisconsin, Milwaukee, WI.
authors: Robert
authors: R
authors: Treat
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors: Jacob
authors: J
authors: Peschman
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors: Matthew
authors: M
authors: Mohorek
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
authors: Philip
authors: P
authors: Redlich
authors: Division of Education/Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors: Travis
authors: T
authors: Webb
mesh_terms: D003142:Communication; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D062209:Patient Handoff / Q000458:organization & administration*; D061214:Patient Safety; D011446:Prospective Studies; D011786:Quality Control; D013043:Specialties, Surgical / Q000193:education*