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Cited by 20Hospital Admissions and OutcomesPatient Safety and Medication ErrorsInnovations in Medical Education

Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative Study to Understand an Increasingly Important Type of Handoff

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Duong, Jonathan A., Jensen, Trevor P., Morduchowicz, Sasha, Mourad, Michelle, Harrison, James D., Ranji, Sumant R.·2017·Journal of General Internal Medicine
DOI 10.1007/s11606-017-4009-yPMC PMC5442018
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Abstract

Background The term "holdover admissions" refers to patients admitted by an overnight physician and whose care is then transferred to a new primary team the next morning. Descriptions of the holdover process in internal medicine are sparse. Objective To identify important factors affecting the quality of holdover handoffs at an internal medicine (IM) residency program and to compare them to previously identified factors for other handoffs. Design We undertook a qualitative study using structured focus groups and interviews. We analyzed data using qualitative content analysis. Participants IM residents, IM program directors, and hospitalists at a large academic medical center. Main measures A nine-question open-ended interview guide. Key results We identified 13 factors describing holdover handoffs. Five factors-physical space, standardization, task accountability, closed-loop verification, and resilience-were similar to those described in prior handoff literature in other specialties. Eight factors were new concepts that may uniquely affect the quality of the holdover handoff in IM. These included electronic health record access, redundancy, unwritten thoughts, different clinician needs, diagnostic uncertainty, anchoring, teaching, and feedback. These factors were organized into five overarching themes: physical environment, information transfer, responsibility, clinical reasoning, and education. Conclusions The holdover handoff in IM is complex and has unique considerations for achieving high quality. Further exploration of safe, efficient, and educational holdover handoff practices is necessary.

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  • The interview guide was previously developed based on sociotechnical theory and will explore key constructs including perceptions of usefulness, resource needs and constraints, barriers and facilitators to implementation, culture of safety, and adaptations.

    “The interview guide was previously developed based on sociotechnical theory and will explore the following key constructs (Table 3): perceptions of usefulness, resource needs and constraints, barriers and facilitators to implementation, culture of safety, and adaptations [13,23].”

    From Improving Communication in Intensive Care Unit to Ward Transitions: Protocol for Multisite National Implementation of the ICU-PAUSE Handoff Tool (2023) · cites this paper as [23]

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Authors
Duong, J. A., Jensen, T. P., Morduchowicz, S., Mourad, M., Harrison, J. D., & Ranji, S. R.
Affiliations
University of California, San Francisco (US)
Corresponding author
Duong, Jonathan A.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2017-02-13
Volume
32
Issue
6
Pages
654-659
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-017-4009-y
PMC
PMC5442018
OpenAlex
W2588064116
Cited by
20
References
23
Citations by year
2026: 1 · 2025: 2 · 2023: 2 · 2022: 6 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 1
FWCI
2.78
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
patient handover, internal medicine residency, physician attitudes, handoff quality, closed-loop verification, diagnostic uncertainty, anchoring effect, clinical reasoning, resident education
MeSH terms
Academic Medical Centers, Humans, Internal Medicine, Internship and Residency, Interprofessional Relations, Medical Staff, Hospital, Outcome and Process Assessment, Health Care, Focus Groups, Qualitative Research, Patient Safety, Patient Handoff

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