 |
|
Transfers of Patient Care Between House Staff on Internal Medicine Wards
A National Survey
Leora I. Horwitz, MD;
Harlan M. Krumholz, MD, SM;
Michael L. Green, MD, MSc;
Stephen J. Huot, MD, PhD
Arch Intern Med. 2006;166:1173-1177.
Background Transfer of responsibility for patient care between physicians is a key process in the care of hospitalized patients. Systems of transfer management and transfer frequency may affect clinical outcomes.
Methods To characterize the systems by which patient information is transferred ("signed out") between resident physicians in internal medicine residency programs and to determine the impact of recently enacted resident work-hour regulations on the frequency of transfers, we mailed a self-administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State. The main outcome measures were sign-out practices, skills training, and transfer frequency.
Results Surveys were returned from 202 programs (62%). Transfer systems varied among and within institutions: 55% did not consistently require both a written and an oral sign-out at transfers of care, 34% left sign-out to interns alone, and 59% had no means of informing nurses that a transfer had taken place. In addition, 60% of the programs did not provide any lectures or workshops on sign-out skills. After work-hour regulations were instituted, transfers of care for a hypothetical patient increased by a mean of 11% (from 7.0 to 7.8 transfers; P<.001) during a Monday-Friday hospitalization. A member of the primary team was in the hospital for 47% of the hospitalization.
Conclusion Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.
Author Affiliations: VA Connecticut Healthcare System, West Haven (Dr Horwitz); and Robert Wood Johnson Clinical Scholars Program (Drs Horwitz and Krumholz) and Department of Internal Medicine (Drs Horwitz, Krumholz, Green, and Huot), Yale University School of Medicine, New Haven, Conn.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure
Schuberth et al.
Circulation 2008;117:2637-2644.
ABSTRACT
| FULL TEXT
The Accreditation Council for Graduate Medical Education's Limits on Residents' Work Hours and Patient Safety: A Study of Resident Experiences and Perceptions Before and After Hours Reductions
Jagsi et al.
Arch Intern Med 2008;168:493-500.
ABSTRACT
| FULL TEXT
The Effects of Resident Work-Hour Regulation on Psychiatry
Rabjohn and Yager
Am. J. Psychiatry 2008;165:308-311.
FULL TEXT
Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey
Borowitz et al.
Qual Saf Health Care 2008;17:6-10.
ABSTRACT
| FULL TEXT
A theoretical framework and competency-based approach to improving handoffs
Arora et al.
Qual Saf Health Care 2008;17:11-14.
ABSTRACT
| FULL TEXT
Evaluating Resident Duty Hour Reforms: More Work to Do
Meltzer and Arora
JAMA 2007;298:1055-1057.
FULL TEXT
Changes in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations
Horwitz et al.
ANN INTERN MED 2007;147:97-103.
ABSTRACT
| FULL TEXT
Hippocrates Affirmed? Limiting Residents' Work Hours Does No Harm to Patients
Goldman and Fiebach
ANN INTERN MED 2007;147:143-144.
FULL TEXT
Update in Critical Care 2006
Milbrandt et al.
Am. J. Respir. Crit. Care Med. 2007;175:638-648.
FULL TEXT
|
