Patient Handoffs: Study of Residents, Nurse Practitioners, and Registered Nurses
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Series/Report no.:2013 Richard J. and Martha D. Denman Undergraduate Research Forum. 18th
Communication breakdowns during resident physician sign-outs in hospitals are a known contributor to patient harm. In one survey study, 59% of resident physicians reported harm to at least one of their patients due to a problematic patient handoff during their last rotation. In response to these issues, the Accreditation Council for Graduate Medical Education (ACGME) instituted Common Program Requirements to ensure that resident physicians are competent in communicating during handoffs, defined as the process of transferring primary authority and responsibility for providing clinical care to a patient from one departing provider to one oncoming provider. To date, there is no known research comparing how resident physicians conduct handoffs as compared to other care providers. Therefore, an observational study was conducted of patient handoffs by resident physicians, nurse practitioners, and registered nurses in two medical intensive care units of one large academic teaching hospital. It was hypothesized that resident physician handoffs would be shorter, more variable, and employ more error detection strategies than registered nurses, but that there would be no differences with nurse practitioners, which have comparable responsibilities as resident physicians. Primary data were transcriptions from digital audio-tapes and handwritten codes collected during real-time observations in digital notebooks. Three observers conducted 23 nurse practitioner patient handoffs, 23 nurse patient handoffs, and 52 resident patient handoffs over an eight month period. Primary measures were the duration of the verbal handoff, information category codes, and error detection strategy codes. The codes were developed from a priori codes from previous research in the field and adapted to our setting and measured based on conversation segment which was segmented by when the topic, the error detection strategy, or the speaker changed.The findings revealed that the hypotheses were supported regarding the comparison between resident physicians and registered nurses. Additional unexpected findings were that resident physicians differed from nurse practitioner handoffs in that they were shorter, more variable, and used more error detection strategies. Therefore, the nurse practitioners occupied a middle position on all of the measures between resident physicians and nurses, likely due to differences in the patient load, culture, procedures, and phone rather than in-person communications. These findings suggest that patient handoffs training could potentially improve efficiency, decrease variability, and increase the effectiveness of error detection by incorporating best practices from multiple disciplines.
Health Professions - Clinical: 3rd Place (The Ohio State University Denman Undergraduate Research Forum)
Academic Major: Biomedical Science
2010-2011 Hospira Research Grant of the National Patient Safety Foundation