Transfers of Patient Care Between House Staff on Internal Medicine Wards

A National Survey

Transfers of responsibility for patient care between physicians are events that are particularly susceptible to communication failure, a critical issue for patient safety. This study, the first national assessment of transfer management in residency programs, describes the management of transfers of care in 324 internal medicine residency programs across the nation and investigates changes in transfer rates since work-hour regulations were implemented which limit resident duty hours.

Key Findings:

  • Residency programs use widely disparate methods of transferring care.
  • More than a third of the programs only used written sign-outs “usually” or “sometimes,” and nearly as many programs were inconsistent in their use of oral sign-outs.
  • Fewer than half of the programs provided formal sign-out skills training.
  • The use of technology to aid in the accuracy and transparency of sign-out was rare.
  • Nurses in the majority of programs were not told that a transfer had taken place and there was no formal mechanism to forward pages.
  • After initiation of work-hour regulations, transfers increased significantly, so that the average patient is now subject to approximately two transfers a day.

Further research is needed to evaluate the content and quality of sign-out information currently provided, the data that ought to be included in the sign-out, and which personnel should participate in sign-out. In addition, the clinical effects of formal sign-out education, night float and transfer frequency warrant closer examination. The finding that transfers are frequent and haphazardly managed lends new urgency to the recent recommendation of the Joint Commission on Accreditation of Healthcare Organizations that safe and effective systems of transfer be developed, evaluated and broadly adopted.