Patient Panel Handoffs for New Interns in Internal Medicine Residency Continuity Clinics

Compared to inpatient care transitions, end-of-year resident continuity clinic panel transitions affect a greater number of patients, yet warm handoffs occur less often.

We developed a program-wide curriculum to implement warm handoffs (defined as in-person or virtual via videoconference) for high-risk continuity clinic patients between graduating and incoming residents.

The warm handoff intervention was phased in at different clinic sites over the study period and ultimately implemented program-wide across nine affiliated continuity clinics. Graduating residents were instructed to identify high-risk panel patients and optimize documentation of key patient care information for handoff. They then participated in a structured, in-person warm handoff event in June during intern orientation involving a direct transfer of information to incoming interns. We surveyed residents between 2017 and 2021 to assess their satisfaction with the continuity clinic handoff process, as well as their perceptions about safety outcomes, comparing those who received a warm handoff to those who did not.

Achieving warm handoffs was feasible, reported by 72% (23/32) of intern respondents by the end of the study period, compared to 43% (13/30) during the first year. Residents who received a warm handoff were more likely to prefer warm handoffs (adjusted odds ratio (aOR) 8.1) and to report satisfaction with the handoff process (aOR 2.7). They were less likely to report having near-misses or adverse events. There were no statistically significant differences in attitudes regarding the importance of outpatient handoffs.

Structured warm handoffs of high-risk resident continuity clinic patients from graduating senior residents to incoming interns are feasible and associated with improved resident satisfaction with the continuity clinic panel transfer process and fewer perceived adverse patient care events during this vulnerable time of transition.