Answering questions on call: pediatric resident physicians' use of handoffs and other resources.

Abstract

BACKGROUND: Little is known in the literature about the types of questions being asked of on-call housestaff and the resources used to provide answers. OBJECTIVE: To characterize questions being asked of pediatric interns on call and evaluate their use of written handoffs, verbal handoffs, and other resources. DESIGN/METHODS: Prospective direct observational study. SETTING: Inpatient wards at an academic tertiary care children's hospital. PARTICIPANTS: Pediatric interns. RESULTS: Trainees were asked 2.6 questions/hour (interquartile range: 1.4-4.7); most involved medications (28%), general care plans (27%), diagnostic tests/procedures (22%), diet/fluids (15%), and physical exams (9%). Interns reported using information provided in written or verbal handoffs to answer 32.6% questions (written 7.3%; verbal 25.3%). Other resources utilized included general medical knowledge, the medical record, and parental report. Questions pertaining to diet/fluids were associated with increased written handoff use (odds ratio [OR]: 3.64, 95% confidence interval [CI]: 1.51-8.76), whereas having worked more consecutive nights was associated with decreased written handoff use (OR: 0.29, 95% CI: 0.09-0.93). Questions regarding general care plans (OR: 2.07, 95% CI: 1.13-3.78), those asked by clinical staff (OR: 1.95, 95% CI: 1.04-3.66), and questions asked of patients with longer lengths of stay (OR: 1.97, 95% CI: 1.02-3.80) were predictive of verbal handoff use. CONCLUSIONS: Pediatric housestaff face frequent questions during overnight shifts and frequently use information received during handoffs to provide answers. A better understanding of how handoffs and other resources are utilized by housestaff could inform future targeted initiatives to improve trainees' access to key information at night.