Current Practice in End-of-Residency Handoffs: A Survey of Internal Medicine–Pediatrics Program Directors

Abstract

Background End-of-residency outpatient handoffs affect at least 1 million patients per year, yet there is no consensus on best practices. Objective To explore the use of formal systems for end-of-residency clinic handoffs in internal medicine–pediatrics residency (Med-Peds) programs, and their associated categorical internal medicine and pediatrics programs. Methods We surveyed Med-Peds program directors about their programs' system for handing off ambulatory continuity patients. Results Our response rate was 85% (67 of 79 programs). Thirty-one programs (46%) reported having a system for end-of-residency handoffs. Of the 30 that offered detailed information, 22 (73%) formally introduced the program to residents, 12 (40%) standardized the handoff, and 14 (47%) used multiple methods for information exchange, with the electronic health record and oral transfer of information (15 of 30, 50%) the most common. Six programs (20%) indicated they did not offer residents protected time to complete end-of-residency handoffs, and 13 programs (43%) did not identify a specific postgraduate year level for residents to whom patients were handed off. Programs were more likely to have a system for end-of-residency handoffs if another categorical program at their institution also had one (P < .001). Conclusions Fewer than half of responding Med-Peds programs have outpatient handoff systems in place. Inclusion of end-of-residency handoff information in the electronic health record may represent a best practice that has the potential of enhancing continuity and safety of care for patients in resident continuity clinics.

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

“…A survey 39 found that only 34% of programs had a year-end handoff process to transition patients from outgoing postgraduate year 3 (PGY-3) residents to incoming PGY-1 residents. Of the 6 articles focusing on ambulatory handoffs, only 3 implemented standardized documentation processes, [40][41][42] and no changes in patient-level outcomes were noted. Doctoroff et al 43 found that residents' patients have lessrobust outpatient follow-up after hospitalization as compared with patients with faculty primary care physicians (PCPs).…”

Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs

“…They found that fewer than half of the responder programs (31/67) had an outpatient handoff system, and the characteristics of those systems were highly variable. 10 In evaluating the scope of what should be included in a handoff, one study revealed that 87% of residents wanted written handoffs for patients with complex medical or social issues, while only 35% felt it would be useful for patients with no significant issues. 11 Handoffs with a structure similar to inpatient handoffs, including a brief summary of active medical conditions and a clinical task list, have been suggested as the most useful format.…”

Patient Safety Outcomes after Two Years of an Enhanced Internal Medicine Residency Clinic Handoff

“…2,5,6 Despite the risks of clinic handoffs, few residency programs have outpatient handoff systems in place, and the few interventions that address clinic handoffs have not reported sustained improvements in patient safety. [7][8][9][10][11][12][13] A multifaceted intervention in psychiatry improved timely follow-up after the clinic handoff. 8,9 In internal medicine, one standardized sign-out intervention improved the number of completed clinical tasks after a clinic handoff and another improved the number of handoffs completed by residents.…”