Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations.

Area of Science:

• Medical Education
• Clinical Diagnostics
• Healthcare Team Dynamics

Background:

• Diagnostic processes are dynamic, team-based activities crucial in teaching hospitals.
• Limited research exists on academic ward teams' diagnostic practices during overnight admission handoffs.
• This study examines team interactions during ward round handoffs.

Purpose of the Study:

• To describe academic ward team operations during overnight patient admission handoffs.
• To characterize the role of bedside patient evaluation in this diagnostic context.

Main Methods:

• Qualitative ethnographic approach utilizing field observations and documentary analysis.
• 35 hours of observation across 5 general medicine ward teams in a teaching hospital.
• Thematic analysis of field notes and electronic health records, informed by social cognitive theories.

Main Results:

• Ward teams dedicated less time to verifying patient history, physical exams, and differential diagnoses during handoffs.
• Bedside patient evaluations and diagnostic discussions were less frequent than other activities, such as reviewing data in conference rooms.
• Observed team-based diagnostic approaches included debriefing for learning and decision-making.

Conclusions:

• The study identifies strengths and missed opportunities in teaching and patient engagement during overnight admission handoffs.
• Findings can inform curriculum development, faculty training, and patient safety research.
• Enhancing bedside evaluations and diagnostic discussions is crucial for improving care and learning.