Hospitalist handoff needs action

By Sarah Guy, medwireNews Reporter

Active listening occurs infrequently between hospitalists as they handoff patients during shift and service changes, show US study results.

While passive listening behaviors such as nodding of the head and eye contact occurred in approximately half of all handoffs in the study, active listening behaviors including note-taking and "reading-back" or repeating occurred significantly less frequently, in approximately one-fifth of situations only.

By contrast, all handoffs studied included question-asking, with the majority forming "clarification" questions, note the researchers.

"Teaching read-back earlier in training in graduate medical education as a receiver-initiated component of the handoff could improve acceptance of this technique," suggest Jeanne Farnan (University of Chicago, Illinois) and co-workers in the BMJ Quality and Safety.

Their findings also reveal that almost all handoffs were interrupted at some point, most often by side conversations.

The study included 48 handoffs involving 19 individual receivers at one hospital that occurred between June and November 2010. Focusing on the "receiving" physician, the researchers evaluated listening styles using the Handoff Evaluation Assessing Receivers (HEAR) checklist, which includes displays of understanding, processing information, and interruptions/distractions.

The median number of patients discussed was eight, and handoffs lasted a mean 12 minutes, report the researchers. Approximately half of handoffs were at shift change (52%, returning physicians), and half were at service change (48%, a new set of shift physicians).

A total of 56%, 50%, and 58% of handoffs included the passive behaviors of affirmatory statements, head nodding, and eye contact, while 17%, 27%, and 23% of handoffs included the active behaviors of read-back, following a printed copy of the handoff notes, and taking notes.

All handoffs included questions, with a mean two questions asked and the majority (65%) relating to clarification. "Next-step" questions were the next most common format, at 35%.

Overall, 98% of handoffs were interrupted, in 72% of cases by side conversations, which ranged in content from personal topics, to professional wellbeing, and systems-based topics; and by pagers going off and clinicians arriving at the handoff in 53% and 50% of situations, respectively.

"Discouraging side conversations during the handoff could be addressed through education and culture change," suggest Farnan et al.

They also recommend systems improvements including protected time from non-emergency pages, and an overlapping, dedicated handoff period per shift and service change.

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