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JAMA Patient Page
December 4, 2013

Patient Handoffs in Teaching Hospitals

JAMA. 2013;310(21):2356. doi:10.1001/jama.2013.283483

When patients are admitted to a teaching hospital, they will most likely be under the care of a team of many doctors.

Resident physicians (residents) are physicians still in training who work under the supervision of attending physicians (attendings). Sometimes medical students will also be on the team.

Residents work in many different types of hospital wards during their training and can switch wards every 2 to 4 weeks. They also work in shifts and have limits on the number of hours they can stay in the hospital. Therefore, each hospital ward has a constant flow of many different residents. At the end of the day, residents working the daytime shift will usually hand over the care of their patients to residents working the nighttime shift. The opposite happens at the end of the night. For example, if you are admitted to the hospital during the night, the nighttime resident takes care of you until the daytime resident arrives in the morning, then the daytime resident will take over your care. This process is known in the medical world as a patient handoff.

How Often Do Patient Handoffs Occur?

Each hospital has its own system in place for patient handoffs. Depending on the hospital, patient handoffs may occur once, twice, or 3 times a day. The number of patient handoffs among residents has been increasing in recent years for many reasons. One reason is the changing work-hour guidelines for residents. In 2011, first-year residents’ shifts were decreased from a maximum of 30 hours to a maximum of 16 hours in all US hospitals. It is important to know that although patient handoffs among residents are frequent, the same attending physician usually stays on service for weeks at a time.

How Do Patient Handoffs Affect Patients?

During a patient handoff, the outgoing resident (Dr A) must pass on information about all of his or her patients to the incoming resident (Dr B) in a way that is organized and efficient. This can be challenging because often Dr A’s patients are new to Dr B. Because of this, Dr B will often need to ask the patients questions that have already been asked by Dr A. This does not mean that Dr B did not read their charts. More likely, he or she prefers to hear some of the information firsthand to make sure nothing important was missed. It may be frustrating for patients to repeat medical information to more than one doctor. But this can be very helpful for residents during the handoff process.

Rarely, miscommunication between residents occurs during patient handoffs. Some information can be missed or passed on incorrectly. There are many rules in place to help prevent this from happening. In the December 4, 2013, issue of JAMA, an article discusses guidelines that were set for residents in one hospital to improve their handoff process.

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For More Information

  • Accreditation Council for Graduate Medical Education
    www.acgme.org

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Many are available in English and Spanish.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Sources: Accreditation Council for Graduate Medical Education
Starmer AJ, Sectish TC, Simon DW, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. doi:10.1001/jama.2013.281961.

Topic: Health Care Delivery

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