Handoffs in general surgery residency, an observation of intern and senior residents

Handoffs have become an area of concern as duty-hour restrictions impose an increasing number of shift changes. The objective of this study was to study handoffs in a general surgery residency and identify problems that exist in the current handoff process in preparation for a standardized implemented protocol.

A resident researcher observed resident-to-resident handoffs for 5 surgical service teams, Monday through Friday, for the middle 2 weeks of the 3rd month of the academic year. Each handoff was observed for the presence, absence, or inconsistency of code status; anticipated problems; active problems; current baseline status; pending tests or consults; and closed-loop communication.

Thirty-eight residents in 2010 were observed, with a total of 52 handoffs ranging from 1 to 27 minutes in length. Five handoffs (10%) were by phone, 47 handoffs (90%) were observed in person, 10 handoffs (19%) were by senior residents, and 37 handoffs (71%) were performed by junior residents. Of the 47 in-person handoffs, code status was mentioned in 2 (4%), and 6 (12%) were given written notes. Of the 37 intern handoffs, the presence of measured criteria occurred in the following percentages: 59% for anticipated problems, 70% for active problems, 51% for current baseline status, 64% for pending tests or consults, and 81% for closed-loop communication. Of the 10 senior-level handoffs observed, all consistently included the previously mentioned criteria.

This study demonstrates the lack of consistency and propensity for error in unstructured handoffs among junior residents. The finding that senior-level residents exhibited consistently proficient handoffs demonstrates that handoffs are a learned skill. Therefore, teaching junior residents a structured handoff supervised by senior residents would most likely reduce the inconsistency and error-prone nature of the junior-level handoffs observed in our study.