TY - JOUR
T1 - ICU Attending Handoff Practices
T2 - Results from a National Survey of Academic Intensivists
AU - Lane-Fall, Meghan B.
AU - Collard, Meredith L.
AU - Turnbull, Alison E.
AU - Halpern, Scott D.
AU - Shea, Judy A.
N1 - Funding Information:
We gratefully acknowledge the following individuals, who contributed to study execution and offered feedback in the early stages of the project: Lee Fleisher, MD, FACC, FAHA; Dennis Harris, MPA; and Meeta Prasad Kerlin, MD, MSCE.
Publisher Copyright:
© 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Objectives: To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs. Design: Cross-sectional electronic survey administered in 2014. Setting: One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education. Subjects: Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists. Interventions: None. Measurements and Main Results: Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (sd, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs. Conclusions: ICU attending handoffs in the United States exhibit marked heterogeneity, and intensivists do not agree about the value of attending handoffs. In addition, some intensivists perceive a link between suboptimal attending handoffs, inappropriate treatment, and serious adverse events that warrants further study.
AB - Objectives: To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs. Design: Cross-sectional electronic survey administered in 2014. Setting: One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education. Subjects: Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists. Interventions: None. Measurements and Main Results: Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (sd, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs. Conclusions: ICU attending handoffs in the United States exhibit marked heterogeneity, and intensivists do not agree about the value of attending handoffs. In addition, some intensivists perceive a link between suboptimal attending handoffs, inappropriate treatment, and serious adverse events that warrants further study.
KW - critical care
KW - health care surveys
KW - medical staff, hospital
KW - patient handoff
KW - patient safety
KW - process assessment (health care)
UR - http://www.scopus.com/inward/record.url?scp=84947765798&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947765798&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000001470
DO - 10.1097/CCM.0000000000001470
M3 - Article
C2 - 26588827
AN - SCOPUS:84947765798
SN - 0090-3493
VL - 44
SP - 690
EP - 698
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 4
ER -