Doc handoff procedures may favor patients at start of list

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 - practice management

Physicians in intensive care units (ICUs) spend approximately 50 percent more time discussing cases at the beginning of their handoff lists than at the end, even though cases are not ordered by severity, according to a study published Nov. 12 in the Archives of Internal Medicine.

Michael D. Cohen, PhD, of the School of Information at the University of Michigan in Ann Arbor, and colleagues estimated that physicians in U.S. hospitals engage in more than 500 million discussions a year in which they go over details about patients as one shift replaces the other. Typically staff review the status of multiple patients in a single handoff session.  

“[T]heoretical analysis in the literature is entirely focused on how best to hand off a single patient,” Cohen and colleagues wrote in a research letter. “As a result, research has overlooked what has been labeled the portfolio problem, how best to allocate across multiple patients the scarce time available for a handoff session.”

The authors video recorded and analyzed 262 patient discussions in 23 end-of-week handoff sessions at an ICU in Kingston General Hospital in Ontario, Canada. Their primary measures were the number of patient discussions, the position on the list of individual patient discussions and the duration. Through interviews, they ascertained that the order of cases was random and did not reflect the severity of illness or the complexity of any given case.

The mean duration of discussion was 142.73 seconds and the median session covered 11 cases. They found that the average time devoted to the discussion declined steadily the farther physicians went down the list. In the median-size session (11 cases), for instance, physicians spent 50 percent more time on the first case than on the last case.

Cohen and colleagues noted that they studied only one site and one type of shift-changing handoff.  But they added the study design easily could be replicated in a larger study. If confirmed, the results could be used to develop methods such as organizing discussions with the most critical cases first and other prioritizing strategies.

In a release, Cohen discussed the possibility of a study to evaluate the implementation of such a strategy on patient outcomes, hypothesizing that it would reduce medical errors. “Just an increase of 1 percent in their effectiveness could translate into a large number of prevented injuries and lives saved,” he said.