Hospital Patients Suffer İn Shift Shuffle

Patient handovers have increased significantly as a result of the restrictions on the number of hours residents are allowed to work. Multiple shift changes, and resulting consecutive sign-outs, during patient handovers are linked to a decrease in both the amount and quality of information conveyed between residents, according to a new study by Dr. Adam Helms from the University of Virginia Healthsystem in the US and his colleagues. Their work which characterizes the complex process of resident sign-out in a teaching hospital, appears online in the Journal of General Internal Medicine, published by Springer.

Multiple shift changes lead to a decrease in continuity of care for patients. Inadequate hand-off of care, or sign-out, leads to interns and residents feeling unprepared for events that happen during cross-cover periods, and in some cases adverse events for patients.

Dr. Helms and colleagues looked at the quality of current resident sign-out processes that occur as patients are handed over to another resident during shift changes, and identified effective strategies for improvement in a US teaching hospital.

The researchers analysed 89 residents' existing attitudes towards the current and ideal sign-out process. System engineers then observed actual sign-outs. The authors also interviewed five residents, whose sign-out process was rated superior by their peers, to determine best sign-out practice.

They found wide variations in the methodology used by residents for sign-out. As many as 40 percent of residents did not expect to make any decisions about patients during cross-over periods. For day shifts, the average duration of sign-outs was just over two minutes versus only one minute for the subsequent night shift sign-out for the same patients. In addition, active problems, treatment plans and lab results were discussed less frequently during the night compared with day sign-out.