Author Affiliations: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia (Dr Jones); New York Academy of Medicine, New York, New York (Mr Kannampallil); and School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston (Dr Franklin).
The recent Research Letter by Cohen et al1 contains interesting conclusions regarding progressively declining time allocations for patients discussed later during rounds. The authors cast the solution for streamlining handoff communication time as a portfolio management problem, where physicians allocate their scarce time available across multiple patients. This argument is both theoretically and metaphorically flawed. First, a portfolio allocation problem assumes 3 conditions: having a set of decision variables (eg, patient conditions), a best-case solution defined as an objective function (eg, all information is efficiently transferred), and available constraints (eg, time). The challenge with applying such a model to handoffs is that constraints and decision variables are rarely known in advance, and it is improbable that such planning happens prior to handoffs, making it difficult to make portfolio judgments. While certain judgments are sometimes made (eg, making the sickest patients a priority), these decisions on time allocations are driven by contextual requirements rather than a portfolio-based allocation.
Jones L, Kannampallil T, Franklin A. End-of-Round Time Compression in Physician Handoff Sessions. JAMA Intern Med. 2013;173(11):1033–1034. doi:10.1001/jamainternmed.2013.412