The Earlier the Longer

Disproportionate Time Allocated to Patients Discussed Early in Attending Physician Handoff Sessions

Often during shift changes, intensive care units (ICU) handoff multiple patients to different personnel. This research letter describes how researchers videotaped and analyzed patient handoff planning sessions. It was the first study to investigate planning for multiple patient handoffs.

There are considerable risks associated with patient handoffs, the transfer of responsibility for a patient from one medical team to another. U.S. hospitals estimate a staggering 500 billion handoffs take place each year, with most occurring during shift changes and involving multiple patients. The authors state, "Existing research has focused primarily on single patient handoffs. As a result, research has overlooked what has been labeled the portfolio problem: how best to allocate across multiple patients the scarce time available for a handoff session."

This research letter describes an investigation in a 21-bed ICU. Researchers videotaped 23 end-of-week handoff sessions. The unit was staffed by two teams and handoff discussions (262 observed) were held among attending physicians and ICU staff. The placement of each patient's bed within the unit determined the order in which ICU personnel discussed the handoffs. Therefore, patient priority was random and unrelated to the severity or any other aspect of a patient's condition.

Key Findings:

  • When a discussion about a patient handoff took place later in a session, the discussion decreased considerably. (Example: the first discussion used at least 50% more time than the last).
  • The median number of discussions in each session was 11.

When planning multiple patient handoffs, ICU teams should consider their complete patient ”portfolios.” This approach can ensure that, even when the severity of patients' conditions varies, teams devote sufficient discussion time to each handoff.