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ICU Attending Handoff Practices: Results From a National Survey of Academic Intensivists

Lane-Fall, Meghan B. MD, MSHP; Collard, Meredith L. BA; Turnbull, Alison E. DVM, MPH, PhD; Halpern, Scott D. MD, PhD, MBE; Shea, Judy A. PhD

doi: 10.1097/CCM.0000000000001470
Clinical Investigations

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.

Supplemental Digital Content is available in the text.

1Department of Anesthesiology and Critical Care and Center for Healthcare Improvement and Patient Safety, Department of Medicine, Perelman School of Medicine; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

2Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

3Division of Pulmonary and Critical Care, Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD.

4Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medical Ethics and Health Policy, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

5Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

This work was done at the University of Pennsylvania Perelman School of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Lane-Fall is employed by Perelman School of Medicine at the University of Pennsylvania (faculty appointment) and receives salary support from the Anesthesia Patient Safety Foundation. She has received grant support from the University of Pennsylvania, Anesthesia Patient Safety Foundation, and the National Institutes of Health (NIH). She has received honoraria and travel support for presentations at academic medical centers in the United States. Dr. Collard was employed by the University of Pennsylvania. Dr. Halpern received support for travel from academic medical centers. His institution received grant support from the NIH, Moore Foundation, RWJF, and Greenwall Foundation. Dr. Shea is employed by the University of Pennsylvania (faculty salary). Dr. Turnbull is employed by the Johns Hopkins University (faculty salary).

Address requests for reprints to: Meghan B. Lane-Fall, MD, MSHP, Department of Anesthesiology and Critical Care, 309 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104. E-mail: laneme@upenn.edu

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