Distractions during resident handoffs: incidence, sources, and influence on handoff quality and effectiveness.

Abstract

Handoffs have significantly increased in number following Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions. Studies have shown correlations between the number of handoffs and errors/patient harm. Distractions are common during handoffs and may interfere with handoff quality and effectiveness. To examine the frequency of distractions and their impact on handoff quality. In this prospective observational study, a total of 214 surgical resident handoffs (residents = 184; Bay area residents [moonlighters] = 30) were observed over 18 months (July 11, 2012-December 19, 2014) by 2 independent observers in 3 teaching hospitals (university, county, and veterans). Handoff quality (both giver and receiver) was assessed using a standardized scoring system. The number and types of distractions were recorded. Pages were the most common distraction (37.5%), followed by telephone calls (32.8%), residents/medical students (9.3%), talking (5.2%), and noise (4.1%). Distractions from attending physicians, electronics, nursing, consults, and room changes were less common (collectively 11%, each <3%). Distractions were present in 102 resident handoffs (48%) (16% with 1 distraction; 15% with 2; 6% with 3, and 11% with ≥4). Distractions occurred in 54% of junior resident handoffs (mean, 1.4/handoff), 30% of moonlighter handoffs (mean, 0.5/handoff), and 38% of senior resident handoffs (mean, 0.89/handoff) (P = .01, junior vs moonlighter/senior). Distractions were more common during evening than morning handoffs (52% vs 36%; P = .045) and during team vs individual handoffs (58% vs 44%; P < .10). Handoffs without distractions were shorter in length (13.2 minutes without distractions vs 21.5 minutes with distractions; P < .001) and minutes per patient (1.78 without vs 2.15 with distractions; P = .04). Handoff quality was not diminished by distractions, as measured by handoff giver score (15.41 without vs 15.47 with distractions; P = .90) and receiver score (7.42 without vs 7.25 with distractions; P = .45). To our knowledge, this is the largest study of distractions during surgical resident handoffs. Distractions were very common during handoffs; they were more common in the evening when junior residents more commonly performed the handoff and they increased the handoff length. However, distractions did not negatively affect the quality of resident handoffs. This may demonstrate the resilience of surgical residents to distractions.