Who to handover: a case–control study of a novel scoring system to prioritise handover of internal medicine inpatients

Bittman, Jesse; Tam, Penny; Little, Chris; Khan, Nadia

doi:10.1136/postgradmedj-2016-133999

Cited by 1 publication

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“…The hand off criteria (iHAND) was developed following a literature review and focus groups of eight clinical faculty members and six CAs. Validation of iHAND was done in a case control analysis of 90 inpatients, where the effectiveness of clinical gestalt, MEWS, and iHAND were evaluated using logistic regression analyses and receiver operating characteristic (ROC) curves [ 12 ]. The iHAND criteria showed a moderately significant correlation with requiring assessment overnight S1 File .…”

Section: Methodsmentioning

confidence: 99%

Structured patient handoff on an internal medicine ward: A cluster randomized control trial

et al. 2018

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BackgroundThe effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes.MethodsThis was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality.ResultsThe intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events.ConclusionsImplementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored.Trial registrationRegistered at ClinicalTrials.gov: NCT01796756.

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Section: Methodsmentioning

confidence: 99%

Structured patient handoff on an internal medicine ward: A cluster randomized control trial

et al. 2018

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Who to handover: a case–control study of a novel scoring system to prioritise handover of internal medicine inpatients

Abstract: The iHAND score had moderate ability to predict which patients required assessment overnight, while MEWS score and current gestalt approach correlated poorly, suggesting the iHAND score may help prioritisation of patients likely to be seen overnight for handover.

Cited by 1 publication

References 39 publications

Structured patient handoff on an internal medicine ward: A cluster randomized control trial

Structured patient handoff on an internal medicine ward: A cluster randomized control trial

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