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Patient Handoffs: Is Cross Cover or Night Shift Better?

Higgins, Alanna MD, MPH*; Brannen, Melissa L. MD; Heiman, Heather L. MD; Adler, Mark D. MD*

doi: 10.1097/PTS.0000000000000126
Original Articles

Objectives Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents.

Methods Surveys assessing provider knowledge of hospitalized patients were administered to pediatric residents. Primary teams were surveyed about their handoff upon completion of daytime coverage of a patient. Night-shift or cross-covering residents were surveyed about their handoff of the same patient upon completion of overnight coverage. Pediatric hospitalists rated the consistency of information between the surveys. Absolute difference was calculated between the 2 providers' rating of a patient’s (a) complexity and (b) illness severity. Scores were compared across provider type.

Results Fifty-nine complete handoff pairs were obtained. Fourteen and 45 handoff surveys were completed by a cross-covering and a night-shift provider, respectively. There was no significant difference in information consistency between primary and night-shift (median, 4.0; interquartile range [IQR], 3–4) versus primary and cross-covering providers (median, 4.0; IQR, 3–4). There was no significant difference in median patient complexity ratings (night shift, 3.0; IQR, 1–5, versus cross cover, 3.5; IQR, 1–5) or illness severity ratings (night shift, 2.0; IQR, 1–4, versus cross-cover, 3.0; IQR, 1–6) when comparing provider types giving a handoff.

Conclusions We did not find a difference in physicians' transfer of information during 2 handoffs among providers taking traditional call or on night shift. Development of tools to measure handoff consistency is needed.

From the *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois; †Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania; and ‡Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Correspondence: Alanna Higgins, MD, MPH, 225 East Chicago Ave, Box 152, Chicago, IL 60611-2991 (e-mail:

The authors disclose no conflict of interest.

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