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| LETTER TO THE EDITOR |
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| Year : 2018 | Volume
: 31
| Issue : 1 | Page : 57-58 |
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Resident-to-resident handoff of primary care practice when transitioning to an inpatient rotation
Stephanie K Nothelle, Laura A Hanyok, Scott Wright, Colleen Christmas
Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| Date of Web Publication | 14-Aug-2018 |
Correspondence Address:
Stephanie K Nothelle
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Building, Center Tower, 2nd Floor, Suite 2200, Baltimore, Maryland 21224
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1357-6283.239051
How to cite this article:
Nothelle SK, Hanyok LA, Wright S, Christmas C. Resident-to-resident handoff of primary care practice when transitioning to an inpatient rotation. Educ Health 2018;31:57-8 |
Dear Editor,
To decrease conflicts between inpatient and outpatient training experiences, many internal medicine residency programs use block scheduling.[1] In this model, while one resident is on an inpatient rotation, a colleague covers his/her outpatient panel. Such transitions introduce the potential for suboptimal care stemming from ineffective handoffs.[2]
Studies of outpatient handoffs in graduate medical education have focused on reassignment of patients when residents graduate.[2] Little is known about handoffs between rotation blocks. We aimed to describe the ambulatory handoff practices within our residency program.
Participants were internal medicine residents at an urban US program which uses block scheduling and does not have a formal system for outpatient handoffs between rotation blocks. Residents who had a transition from outpatient to inpatient during the study period (January 3–May 28, 2015) were identified and surveyed (n = 40).
Residents were given a list of their patients. They identified (1) those who they were concerned would require a covering provider's attention (2) patients they handed off.
For each resident, we recorded characteristics including postgraduate year (PGY), gender, residency track (primary care vs. categorical), patient panel size, and number of days on an inpatient and outpatient basis. We reviewed patients' charts and abstracted data, including the number of prescription medications as a marker of comorbidity.[3]
We used descriptive statistics to summarize resident characteristics by PGY and patient characteristics by resident concern and handoff completion. We made comparisons using t-test, Chi-square test, and ANOVA where appropriate. The Institutional Review Board exempted this study from needing a full review.
Twenty-six residents participated [65%, [Table 1]. Collectively, these residents cared for 1715 patients. For 37 patients (2%), a handoff was completed. Two hundred and sixty patients (15%) were identified as being “of concern” to require attention from a covering resident. The patients eliciting worry were mostly female (n = 136, 57%), with a mean age of 55 years (standard deviation [SD] 15) and a mean number of prescription medications of 7 (SD 4.2). | Table 1: Characteristics of 26 resident participants and variables related to ambulatory handoffs
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Of the patients handed off, the residents were concerned about 92% (n = 34). Patients actually handed off were similar in age and gender to the larger group “of concern” (both P > 0.05); however, they took a mean of 9.4 prescription medications (SD = 5.2), which was significantly higher than the other patients identified (P = 0.03).
Consistent with other articles, our study shows that residents are concerned about the care of their outpatients while they are unavailable.[4] Different from prior work,[5] these concerns did not necessarily lead to handoffs.
Studies of year-end transfers of care demonstrate risk for suboptimal patient outcomes, which may be lessened with the use of a handoff tool.[2] One such tool, used by residents for outpatients between block handoffs, was rated by trainees as valuable and lessened their concerns for patients.[4] Future studies will determine the impact of handoff tools on ambulatory patient outcomes.
This study highlights the finding that residents are genuinely concerned about their outpatients while they are away from the practice, but that this unease has not translated into behaviors or action. Innovations that improve coverage and enhance communication between providers, such as handoff tools, may enhance patient care.
Dr. Nothelle's work is supported by Health Resources and Services Administration Geriatrics Workforce Enhancement Program.
Dr. Christmas's work is supported by a grant from the Paul Zimmermann Fund for Development of Primary Care, Geriatrics, and Quality at the End of Life.
Dr. Hanyok's work is supported by the Joshua Macy Jr. Foundation.
Dr. Wright is a Miller-Coulson Family Scholar and this support comes from the Hopkins Center for Innovative Medicine.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Heist K, Guese M, Nikels M, Swigris R, Chacko K. Impact of 4 + 1 block scheduling on patient care continuity in resident clinic. J Gen Intern Med 2014;29:1195-9.  |
| 2. | Phillips E, Harris C, Lee WW, Pincavage AT, Ouchida K, Miller RK, et al. Year-end clinic handoffs: A national survey of academic internal medicine programs. J Gen Intern Med 2017;32:667-72. |
| 3. | Perkins AJ, Kroenke K, Unützer J, Katon W, Williams JW Jr., Hope C, et al. Common comorbidity scales were similar in their ability to predict health care costs and mortality. J Clin Epidemiol 2004;57:1040-8. |
| 4. | Long T, Uradu A, Castillo R, Brienza R. Addressing outpatient continuity for ambulatory training: A novel tool for longitudinal primary care sign out. Educ Health (Abingdon) 2016;29:51-5. |
| 5. | Horsky J, Suh EH, Sayan O, Patel V. Uncertainty, case complexity and the content of verbal handoffs at the emergency department. AMIA Annu Symp Proc 2015;2015:630-9. |
[Table 1]
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