Equity in Handoff Practices: A Qualitative Project on Handoffs of Patients with Limited English Proficiency

Handoffs are critical information exchanges between healthcare providers. Patients with limited English proficiency (LEP) face increased risk of adverse events from inadequate handoffs; however, the impact of current handoff practices on their care remains understudied.

To understand hospitalists' preferences for, assess current practices of, and develop recommendations to improve handoffs of patients with LEP.

Analysis of qualitative surveys and handoff observations.

Hospitalists at an urban medical center from November 2022 to June 2024.

A multidisciplinary team of system designers and healthcare professionals integrated qualitative methods with novel systems design and ethnographic practices. Phase 1 involved a qualitative survey assessing hospitalist preferences for handoffs of patients with LEP, analyzed using thematic analysis. These findings informed phase 2, verbal and written handoff observations. An abductive analytical framework, developed by the system designers, guided the analysis of both phases' findings and the development of handoff recommendations.

For handoffs of patients with LEP, hospitalists emphasized the importance of communication practices and social information, including language preference, LEP status, and support systems. Several perceived no difference in how handoffs should be conducted for patients with LEP versus patients with English proficiency (EP). Observation of 26 hospitalists, encompassing 111 patient handoffs, revealed frequent omissions of the communication/social information identified as important in phase 1. In total, 59.3% (16/27) of handoffs of patients with LEP omitted language preference. Verbal handoffs of patients with LEP were less comprehensive than those of patients with EP conducted by the same hospitalist. These findings informed the development of five recommendations to enhance handoffs of patients with LEP.

This project revealed a mismatch between the ideal and current state of handoffs of patients with LEP. We developed five targeted recommendations to improve handoffs of this population, laying a foundation for equity-focused tools for care transitions.