Open Access
Transfers of Patient Care Between House Staff on Internal Medicine Wards
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TLDR
In this article, a self-administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State was conducted to characterize the systems by which patient information is transferred between resident physicians in internal medicine residencies and to determine the impact of resident work-hour regulations on the frequency of transfers.Abstract:
BACKGROUND
Transfer of responsibility for patient care between physicians is a key process in the care of hospitalized patients. Systems of transfer management and transfer frequency may affect clinical outcomes.
METHODS
To characterize the systems by which patient information is transferred ("signed out") between resident physicians in internal medicine residency programs and to determine the impact of recently enacted resident work-hour regulations on the frequency of transfers, we mailed a self-administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State. The main outcome measures were sign-out practices, skills training, and transfer frequency.
RESULTS
Surveys were returned from 202 programs (62%). Transfer systems varied among and within institutions: 55% did not consistently require both a written and an oral sign-out at transfers of care, 34% left sign-out to interns alone, and 59% had no means of informing nurses that a transfer had taken place. In addition, 60% of the programs did not provide any lectures or workshops on sign-out skills. After work-hour regulations were instituted, transfers of care for a hypothetical patient increased by a mean of 11% (from 7.0 to 7.8 transfers; P<.001) during a Monday-Friday hospitalization. A member of the primary team was in the hospital for 47% of the hospitalization.
CONCLUSION
Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.read more
Citations
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The published literature on handoffs in hospitals: deficiencies identified in an extensive review
TL;DR: The existing literature on patient handoffs does not yet adequately support either definitive research conclusions on best handoff practices or the standardisation of handoffs that has been mandated by some regulators.
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National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training
Karl Y. Bilimoria,Jeanette W. Chung,Larry V. Hedges,Allison R. Dahlke,Remi Love,Mark E. Cohen,David B. Hoyt,Anthony D. Yang,John L. Tarpley,John D. Mellinger,David M. Mahvi,Rachel R. Kelz,Clifford Y. Ko,Clifford Y. Ko,David D. Odell,Jonah J. Stulberg,Frank R. Lewis +16 more
TL;DR: Flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality.
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Consequences of inadequate sign-out for patient care.
TL;DR: Omission of key information during sign-out can have important adverse consequences for patients and health care providers.
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Residents' and attending physicians' handoffs: a systematic review of the literature.
Lee Ann Riesenberg,Jessica Leitzsch,Jaime L. Massucci,Joseph Jaeger,Joel C. Rosenfeld,Carl Patow,Jamie S. Padmore,Kelly P. Karpovich +7 more
TL;DR: There is a great need for high-quality handoff outcomes studies focused on systems factors, human performance, and the effectiveness of structured protocols and interventions.
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A model for building a standardized hand-off protocol.
TL;DR: Analysis of protocols demonstrated that the hand-off process is highly variable and discipline-specific, and this model for design and implementation can be applied to other health care settings.
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