Characterization of Pediatric Resident Handover at Change of Shift to Inform Process Improvement

Incomplete and/or unclear transfer of patient information can adversely affect the quality of patient care. This study investigated what/how information is exchanged between resident physicians at shift change. 15 sign-outs consisting of 209 patients were observed. Ten categories of patient information, four types of communication, and three sources of distraction were developed to characterize sign-out. The average sign-out lasted 34.4 minutes (standard deviation of 15.9) with 13.9 patients (standard deviation of 3.5) discussed. 23.2% of the time did not focus on patient care. When discussing patient care, 87.2% included one-way information transfer from the resident going off call. 32.2% of the information consisted of prior patient background. 12.1% was spent discussing what actions should/may occur overnight. Residents discussed the current physical condition for 35.4% of the patients, current medications for 62.7%, and contingency plans for 17.7% of patients. Potential improvements should focus on training residents on how to conduct handovers.