Blog | Friday, October 17, 2014

How can we make hand-offs a good thing?

Health care is actually a 24-hour-a-day, 7-day-a-week job. People get sick even when we physicians are supposed to be sleeping or eating dinner or showering or brushing our teeth. Having care available all the time often saves lives and usually reduces suffering. In the U.S., we have that pretty well worked out. Everyone with a doctor has an after-hours number to call and if that fails or the problem is too big, there is always an emergency room or at least an ambulance or fire truck to whisk one away to where help is waiting.

One of the problems with our after-hours options is that a person is rarely seen by a doctor who knows them and is familiar with their medical history. It would be ideal for all of us to have rapid access to the doctor (or nurse practitioner or physician’s assistant) who has been with us for years and who knows what works, what doesn’t and who we can relate to and trust. Unfortunately that person has to sleep and eat dinner and sometimes even go on vacations. Most people run into the reality of seeing different doctors depending on who is available.

In my present profession, hospital medicine, I work for several days in a row taking care of a collection of patients who are in the hospital at that time. Most of them I don’t know. When I have days off, I tell another hospitalist about the patients I’ve been seeing and write a rather complete note. We discuss how I envisioned managing the patients’ medical problems, as I understand them and then I go, and Doctor Next takes the helm.


Not all hospitalist programs have “face to face sign-outs.” It is ideal to sit with the doctor who is assuming care of my patients and explain what is going on. That becomes impractical if there are too many patients and when I am not physically working at the same time as the physician assuming my patient’s care, like in places where there is a night shift physician. Telephone sign-outs are not bad, but are also impractical in a big hospitalist group where my 18 or 20 patients may go to several different doctors when I leave. A good sign-out, in person, from a good doctor is key to not being completely helpless on the first day of a set of shifts. Nevertheless, much can be gleaned from reading progress notes and reviewing labs and sometimes that’s all there is, since two minutes sign-out times 20 patients on a service equals 40 minutes, which is way too much time and still not enough detail to really be helpful.



