title: Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.
abstract: BACKGROUND
  While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern.
  
  
  OBJECTIVE
  The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country.
  
  
  METHODS
  Nationwide survey.
  
  
  METHODS
  All internal medicine program directors registered with APDIM.
  
  
  METHODS
  Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs.
  
  
  RESULTS
  Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff.
  
  
  CONCLUSIONS
  Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.
authors.affiliation: Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA. erp2001@med.cornell.edu.
authors.forename: Erica
authors.initials: E
authors.lastname: Phillips
authors.affiliation: Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Harris
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Wei Wei
authors.initials: WW
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Amber T
authors.initials: AT
authors.lastname: Pincavage
authors.affiliation: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Ouchida
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Miller
authors.affiliation: Department of Medicine, Memorial Healthcare System, Hollywood, FL, USA.
authors.forename: Saima
authors.initials: S
authors.lastname: Chaudhry
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D062209:Patient Handoff / Q000592:standards*; D061214:Patient Safety / Q000592:standards; D010865:Pilot Projects; D011795:Surveys and Questionnaires
keywords: continuity of care; handoff; patient safety; sign-out; transfer of care