2017 HSC Section 2 - Practice Management

ARTICLE IN PRESS

Hasan et al

Fig 2. Time per patient handoff as a function of the number of patients being handed off. (Color version of this figure is available online.)

Table III. Distraction categories noticed by source and receivers Source Receiver 1 Receiver 2 Any distraction 71 78 67 Internal noise (% yes) 56 71 62 Hunger (% yes) 26 22 23 Void (% yes) 6 4 0 Thirst (% yes) 17 17 15 Pain (% yes) 1 5 0 Fatigue (% yes) 37 60 28 Other (% yes) 1 1.2 0 Personal distractions (% yes) 12 12.2 18 External noise (% yes) 39 44 41 Extraneous staff 28 31 15

Table IV. Observer 1 and observer 2 comparison using ICC ( N = 23) ICC P value Handoff duration (min) 0.983 < .001 Number of patients per handoff 0.986 < .001 Number of extraneous staff entering/exiting room 0.912 < .001

Background conversation by extraneous personnel (Y/N) Number of side conversations by handoff providers Number of handoff interruptions due to pager beeps/phone Number of handoff interruptions due to extraneous staff talking to handoff staff Number of unrelated teaching discussions interrupting handoff Were any electronic devices on during handoff? Rate handoff delivery (1–5) Rate handoff reception (1–5) Rate handoff environment (1–5)

0.667

< .001

0.394

.032

0.765

< .001

0.659

< .001

entering/exiting the room (% yes)

0.209 NS

Background conversation by extraneous staff (% yes) Side conversations by handoff staff (% yes) Teaching discussion during handoff (% yes)

5 17

3

0.167 NS

6

2

3

0.556

.001

0.062 NS

4

4

0

0.447

.016

NS , Not significant ( P value > .05).

Unrelated electronics on during handoff (% yes)

10

9

28

ICC was used to compare different participants of the study. Observers 1 and 2 were found to have a strong ICC when counting distractions and evaluating the handoff delivery process and hand- off environment ( P < .05). In contrast, the 2 ob- servers diverged when evaluating the handoff reception process ( P > .05; Table IV ). Also, the 2 receivers diverged in evaluating the type of

observer when a PGY-2 or higher-level resident delivered the handoff, compared with PGY-1 resi- dents (mean of 4.3 vs 3.6, P < .001). The receiver scores did not show a difference based on the source PGY resident level ( P = .56).

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