Marisha Burden

A structured handoff program for interns.

Purpose To develop, teach, and supervise a structured process for handing off patient care and to evaluate its effect on interns’ knowledge, skills, and attitudes toward handoffs. Method The authors developed a formal process for interns on the medicine ward services to hand off patient care at their teaching hospital. In July 2006, attending physicians began to teach and supervise the process. To evaluate the entire structured handoff program (the process, teaching, and supervision), interns were surveyed on the first day and during the last week of each of their month long rotations. Results From June through December 2006, the authors obtained 137 of 144 surveys (95% response) they had administered to 72 consecutive interns rotating through the hospital. During the first three months of the academic year, first-year interns had little confidence in their ability to hand off patients, make contingency plans, or perform read-backs when they began their rotations, but after exposure to the handoff program, their perceptions of these abilities increased (all P < .05). Eighty-five percent of the interns felt that attending supervision of the handoff process was useful or extremely useful, but only 51% viewed the lecture/small-group session about handoffs as useful. Conclusions The structured handoff program improved the participating interns’ perceptions of their knowledge of the handoff process and their ability to transfer the care of their patients effectively. The formal program for teaching handoffs, that included attendings’ supervision of the process, was well received.

Prospective comparison of curbside versus formal consultations

BACKGROUND Curbside consultations are commonly requested during the care of hospitalized patients, but physicians perceive that the recommendations provided may be based on inaccurate or incomplete information. OBJECTIVE To compare the accuracy and completeness of the information received from providers requesting a curbside consultation of hospitalists with that obtained in a formal consultation on the same patients, and to examine whether the recommendations offered in the 2 consultations differed. DESIGN Prospective cohort. SETTING University-affiliated, urban safety net hospital. MAIN OUTCOME MEASURES Proportion of curbside consultations with inaccurate or incomplete information; frequency with which recommendations in the formal consultation differed from those in the curbside consultation. RESULTS Curbside consultations were requested for 50 patients, 47 of which were also evaluated in a formal consultation performed on the same day by a hospitalist other than the one performing the curbside consultation. Based on information collected in the formal consultation, information was either inaccurate or incomplete in 24/47 (51%) of the curbside consultations. Management advice after formal consultation differed from that given in the curbside consultation for 28/47 patients (60%). When inaccurate or incomplete information was received, the advice provided in the formal versus the curbside consultation differed in 22/24 patients (92%, P < 0.0001). CONCLUSIONS Information presented during inpatient curbside consultations of hospitalists is often inaccurate or incomplete, and this often results in inaccurate management advice.

Postdischarge problems identified by telephone calls to an advice line

BACKGROUND Problems experienced after hospital discharge can result in rehospitalizations and unscheduled urgent and emergent care. OBJECTIVE To identify opportunities for improving discharge processes by examining calls to an advice line (AL). DESIGN Prospective cohort. SETTING A 500-bed, university-affiliated hospital. PATIENTS Patients who called an AL between September 1, 2011 and September 1, 2012 and reported being hospitalized within 30 days. INTERVENTION None MEASUREMENTS Caller characteristics, timing of calls, nature of reported problems. RESULTS Over 1 year the AL received calls from 308 unique patients who were hospitalized or had outpatient surgery within 30 days preceding the call. Thirty-one percent and 47% of calls occurred within 24 or 48 hours of discharge, respectively. Sixty-three percent came from surgery patients despite surgery patients accounting for only 38% of the discharges. The most common issues were uncontrolled pain, questions about medications, and aftercare instructions (eg, the care of surgical wounds). The rates of 30-day readmissions and urgent or emergent care visits were higher for patients who called the AL than for those who did not (15% vs 4% and 30% vs 7%, respectively, both P < 0.0001), but sample sizes were too small to accommodate robust matching or multivariate analysis. CONCLUSIONS Problems described in calls by patients to an AL identified several aspects of our discharge processes that needed improvement. Patients calling an AL following discharge may be at increased risk for 30-day rehospitalization and urgent or emergent care visits.