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ICU Attending Handoff Practices: Results From a National Survey of Academic Intensivists.
Crit Care Med. 2016 Apr;44(4):690-8
Authors: Lane-Fall MB, Collard ML, Turnbull AE, Halpern SD, Shea JA
Abstract
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.
PMID: 26588827 [PubMed - indexed for MEDLINE]