Table 2.
Handoff characteristics (N = 210)
| Topic area | No. (%) |
|---|---|
| Handoff process (panel reassignment) | |
| To incoming intern | 83 (39) |
| Divided among interns and residents | 73 (34) |
| Divided among >1 intern | 49 (23) |
| Patient factor-dependent | 29 (14) |
| To PGY-2 or PGY-3 | 18 (8) |
| To an attending | 15 (7) |
| No standard reassignment | 11 (5) |
| Other | 7 (3) |
| Don’t know | 4 (2) |
| Format of written information transfer (sign-out) | |
| Update chart problem list | 82 (39) |
| Not expected to prepare a sign-out | 79 (38) |
| Electronic or written sign-out document placed in patient’s chart | 53 (25) |
| Electronic or written sign-out document signed face-to-face | 20 (10) |
| Electronic or written sign-out document given to accepting provider | 19 (9) |
| Don’t know | 13 (6) |
| Handoff education | |
| Educate residents on how to conduct end-of-year handoff | 67 (31) |
| Re-balance caseload to distribute complex patients equally | 35 (16) |
| Faculty supervision or involvement in clinic handoff process | 34 (16) |
| Provide standardized template for written sign-out | 33 (15) |
| Provide protected time for handoff activities (i.e., preparation, face-to-face handoff) | 32 (15) |
| Introduce incoming resident PCP in person during visit with outgoing resident | 18 (8) |
| Assess competency of residents in handoff process | 9 (4) |
| None of the above | 82 (35) |
| Don’t know | 18 (8) |
| Patient care processes | |
| Communicate to patients about pending transition | 98 (46) |
| Identify high-risk patients at risk for poor handoff outcomes | 48 (22) |
| Provide enhanced handoff for high-risk patients | 38 (18) |
| Schedule high-risk patients with a designated provider | 23 (11) |
| Monitor patients lost to follow-up after year-end handoff | 16 (8) |
| Monitor time to first appointment for handoff patients | 14 (7) |
| Provide patients with additional outreach at transition point | 14 (7) |
| None of the above | 57 (24) |
| Don’t know | 23 (10) |
| Barriers to year-end handoff process | |
| Not enough overlap between outgoing and incoming residents | 87 (41) |
| Unable to schedule patients with new interns until their schedule is available | 71 (34) |
| Too time-intensive for house staff | 67 (32) |
| Too time-intensive for supervising attending physicians | 54 (25) |
| Too time-intensive for support staff | 49 (23) |
| Lack of patient continuity in resident clinic | 49 (23) |
| Residents don’t feel sense of ownership of clinic patients | 41 (20) |
| Unable to identify a resident as the primary care provider in patient record | 39 (18) |
| Program culture does not deem it necessary | 26 (13) |
| Unable to perform high-priority scheduling for high-risk patients | 23 (11) |
| No barriers | 22 (10) |
| Unable to identify high-risk patients | 13 (6) |
| Other/don’t know | 28 (13) |
PGY postgraduate year