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Room to Improve Order, Length of Doc Handoff Discussions

Order of discussions random, but 50 percent more time given to those discussed first versus last

THURSDAY, Nov. 15 (HealthDay News) -- In handoff discussions between attending physicians in an intensive care unit, more time is allocated to patients discussed early in each session compared with those discussed last, despite the order of cases being unrelated to severity or complexity of illness, according to research published online Nov. 12 in the Archives of Internal Medicine.

Michael D. Cohen, Ph.D., of the University of Michigan in Ann Arbor, and colleagues video recorded 262 patient discussions in 23 handoff sessions between experienced attending physicians in the intensive care unit of a tertiary medical center

The mean session duration was 142.73 seconds, with a median of 11 discussions per session. Despite the fact that the order of cases discussed did not depend on the severity or complexity of illness, the researchers found that the average time allocated to discussion decreased steadily with increasing ordinal position. In a median-sized session, the patient case discussed first received about 50 percent more time than the case discussed last.

"To our knowledge, this study of discussion order and duration is the first of its kind. It has the limitations of involving one site and one particular type of handoff," the authors write. "However, it is easily replicated, and, if confirmed, it suggests that shift-change handoffs and handoff training programs should include methods for explicitly controlling the allocation of scarce time across the portfolio of patients discussed."

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