Abstract 212: Evaluation of Written Materials for Patient Handoffs on an Inpatient Cardiology Service

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Background/Aims: Transferring responsibility of patient care (handoff) is an increasingly frequent occurrence in hospitals, with the potential for errors leading to adverse outcomes. Written patient summaries are commonly used to facilitate information transmission during handoff and may be integrated into the electronic health record. No prior studies have examined cardiology-specific handoff practices or assessed differences in handoff needs by provider class. We aimed to evaluate the elements of written handoff requested and provided by clinicians on a large academic inpatient cardiology service. Methods: We performed an online survey of resident, fellow, nurse practitioner (NP), physician assistant (PA), and attending physician providers. Providers selected requested elements of written handoff from a list of 31 potential elements. An ANOVA was used to compare the difference in the mean number of requested elements between provider groups. Subsequently, we audited written handoff materials for inclusion of commonly requested elements. Results: Of 161 invitations there were 95 responses (59% response rate) including 38 residents, 26 fellows, 20 attending physicians, and 11 NP/PAs. The Figure shows the frequency of the top 10 most requested elements of all providers. Compared with residents (mean 18.4), significantly fewer elements were requested by fellows (13.5), NP/PAs (13.5), and attending physicians (13.2) (p<0.05 for each comparison). Audit of 661 written handoffs identified rate of inclusion of 6 requested elements: admitting diagnosis, 92% (610 of 661); general hospital course/events of last shift, 70% (464 of 661); tasks to complete, 69% (455 of 661); ejection fraction, 52% (346 of 661); anticipatory guidance, 32% (212 of 661); and the overall health status, 14% (92 of 661). Conclusions: We identified elements of written handoff commonly requested by cardiology providers in a large academic hospital. Residents request more written information than other providers. On review of clinical materials, we found even the most frequently requested elements were often omitted. These data provide the rationale for a standardized cardiology written handoff to include conserved requested elements.