PURPOSE: Improvement in effective communication is integral to patient safety especially in the critical care setting. We studied the hand off practices amongst pulmonary/critical care fellows to measure the degree of correlation between hand off providers and recipients and factors that influenced this hand off.
METHODS: Daytime and night-time pulmonary/critical care fellows in the MICU were surveyed at random for a two month period of time after they had completed their hand off communication. Fellows were given a survey asking them to detail the three most active patients and their respective problem(s). They were asked to comment on their perception of how “complete” their hand off was as well as the acuity of the MICU patients.
RESULTS: Twenty-one hand-offs (17% of the total hand-offs during a 2 month period) were examined during which 209 patients were discussed. There was never complete correlation between the on-coming fellow and post-call fellow with regards to the top three patients or problems. Both fellows agreed on the same two patients 48% of the time, agreed on one patient 48% of the time and had no agreement on patients 4% of the time. The two fellows agreed on two of three problems 43% of the time, one of the three problems 38% of the time, and agreed on none of the problems, 19% of the time. The post-call fellow’s perception of the completeness of their hand-off was measured at 4.0 out 6.0 compared to the on-coming fellow’s perception of completeness measured at 5.1 out of 6.0 (p=0.002). The post-call fellow’s perceived acuity of the MICU was an average of 4.3 out of 6.0 compared to the on-coming fellow’s perceived acuity of 3.9 out of 6.0 (p=0.05).
CONCLUSIONS: Our current hand-off practice fails to effectively communicate prioritized issues in the MICU. The on-coming fellow over-estimated the completeness of the hand-off and underestimated the acuity of the MICU.
CLINICAL IMPLICATIONS: The current hand-off practices amongst MICU fellows provide suboptimal communication.
DISCLOSURE: The following authors have nothing to disclose: Koonj Shah, Uma Ayyala, Thomas Kalb
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