Inpatient Hand-Offs in Family Medicine Residency Programs: A CERA Study

BACKGROUND AND OBJECTIVES: Miscommunication during patient hand-off in the inpatient setting can lead to serious medical errors. Previous studies indicate heterogeneity in handoff practices among physicians in training. We sought to determine current practice patterns of patient hand-offs in family medicine residencies and training methods to reinforce effective transfer of care. METHODS: We developed 13 questions relating to patient hand-offs that were included in the Spring 2014 CERA Family Medicine Program Directors Survey. Descriptive statistics were generated for each survey item. RESULTS: We received 224 survey responses (response rate of 50%). The typical inpatient was subject to an average of seven transfers of care from a Thursday morning to a Monday morning. Use of two strategies consistent with best practices (face-to-face hand-off, use of a dedicated area) was very high. There was wide variation in training methods for patient transfer and infrequent use of national resources. Half of all residency programs relied on supervision as the primary method of instruction in patient hand-off. Estimated patient safety events in the last year attributed to a breakdown in hand-off procedure occurred “rarely/never” in 73% of programs. CONCLUSIONS: The vast majority of family medicine residencies use at least two of three best practices in patient hand-offs, though there was wider variation in the processes of hand-offs. Frequent hand-offs associated with a night float system is a potential cause of increased errors, though we were unable to measure actual patient safety events.