Admission handoff communications: clinician's shared understanding of patient severity of illness and problems

Communication errors are a leading cause of medical mistakes. Handoff communications during the admission of a patient are a critical point of communication during which patient care is transferred from one clinician to another. The transmission of the patient's current severity of illness and active problems is integral to this communication. Our objective was to determine if this information is conveyed by the current handoff process between resident physicians.

We recorded admission handoff communications between residents and then asked each resident to independently rate the patient's severity of illness and to list the patient's problems. The scores and lists were compared for agreement. Attending physicians listened to the recordings and also assessed severity of illness and patient's problem lists.

Three quarters of the handoffs had agreement about the severity of the patient's illness. However, there was low agreement about the most severe problem and the total problem lists between residents involved in the handoff communication. Attending physicians were able to identify more patient problems.

We conclude that information needed to assess the patient's severity of illness and problems may have been present in the handoff communications but may not have been fully received and integrated by the residents. In addition, attending physicians may have an additional capacity to "infer"" information, perhaps because of prior clinical experience or expertise. This study implies that residents may need more formal education, training, and evaluation of their handoffs to improve patient safety.