One of the consequences of capping resident work-hours is increasing the frequency of patient hand-offs.
In a recent column in The New York Times, surgeon Pauline Chen cites a somewhat frightening statistic that during a course of a typical 5-day hospitalization, patients “are passed between doctors an average of 15 times.”
And residents sign over patients several hundred times during the first few weeks of training.
One interesting solution would be to model physician hand-offs on how nurses do it. When nurses hand-off patients at the end of shift, it’s often in a quiet, undisturbed room. Contrast that to doctors, where patient hand-offs are performed quickly, often interrupted by pages.
Indeed, according to Vineet M. Arora, a physician who studies the effects of patient hand-offs, nurses have a “culture that has developed around [hand-offs]. In contrast, physicians have historically emphasized continuity much more than handoffs. As a result, doctors’ signouts happen quickly, last-minute and on the fly.”
That’s a great point, and something that needs to start early in physician training. As Dr. Arora states, “handoffs are a priority and not an afterthought.”