Atlantic Health System–Goryeb Children's Hospital, Morristown, NJ
How Simple Technology Can Improve Physician-to-Physician Patient Handoff

Abstract

Background: On our institution's pediatric inpatient unit, a number of admissions arrive on the floor without a formal physician-to-physician handoff. Pilot data revealed that handoffs, especially from the pediatric surgical service, were limited. The purpose of our study was to develop a streamlined method of communication between multiple disciplines and the inpatient pediatric admitting resident to increase the handoff rate.

Methods: A team was formed of members from the pediatric and general pediatric surgical services. A new portable telephone was introduced that the admitting pediatric resident carried 24 hours a day, 7 days a week. Once the telephone was obtained, verbal and written instructions were provided to all disciplines that admit to the inpatient unit (ie, ED, surgical teams, subspecialists, and outpatient general pediatricians). For a 6-week period, data were collected on the handoff rate for pediatric inpatient admissions. After the initial data collection, results were analyzed, and a second intervention—a feedback session with the general pediatric surgical team—was performed. Data were then collected for an additional 6-week period.

Results: During the first 6 weeks after the telephone procedure was implemented, the percentage of completed handoffs was 96% from the ED, 38% from surgery, and 5% from the subspecialties. In the second 6 weeks, after the second intervention, ED and the subspecialties had 100% admissions with completed handoffs, whereas surgery decreased to 20%. The percentage of handoffs done using the telephone during the first 6 weeks was 60% from the ED, 50% from surgery, and 0% from the subspecialties. After the second intervention, the ED made 100% of handoffs using the phone, the subspecialties had 11% of handoffs with the phone, and surgery had 22% of handoffs with the phone.

Conclusions: The literature has shown the paramount importance of proper physician-to-physician handoff. One hundred percent of ED and subspecialty admissions now have a formal handoff. Streamlining the process and ensuring that admitting residents are easily accessible should encourage more physicians to hand off their patients when transferring or admitting them to the pediatric floor. Our data indicated an improved number of handoffs from the subspecialists, although the use the new telephone was limited, suggesting a halo effect of the project. The surgical teams did not adopt the process. Future steps will seek to engage the surgeons—more specifically the nonemployed surgical subspecialists—in the handoff process.