Volume 8, Issue 6 p. 328-333
Original Research

Answering questions on call: Pediatric resident physicians' use of handoffs and other resources

Maireade E. McSweeney MD, MPH

Corresponding Author

Maireade E. McSweeney MD, MPH

Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston Massachusetts

Address for correspondence and reprint requests: Maireade E. McSweeney, MD, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA 02115; Telephone: 617-355-7036; Fax: 617–730-0495; E-mail: [email protected]Search for more papers by this author
Christopher P. Landrigan MD, MPH

Christopher P. Landrigan MD, MPH

Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston Massachusetts

Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital Boston, Harvard Medical School, Boston, Massachusetts

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Hongyu Jiang PhD

Hongyu Jiang PhD

Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston Massachusetts

Clinical Research Center, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

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Amy Starmer MD, MPH

Amy Starmer MD, MPH

Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston Massachusetts

Division of General Pediatrics, Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon

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Jenifer R. Lightdale MD, MPH

Jenifer R. Lightdale MD, MPH

Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston Massachusetts

Clinical Research Center, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

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First published: 16 April 2013
Citations: 8

Abstract

BACKGROUND

Little is known in the literature about the types of questions being asked of on-call housestaff and the resources used to provide answers.

OBJECTIVE

To characterize questions being asked of pediatric interns on call and evaluate their use of written handoffs, verbal handoffs, and other resources.

DESIGN/METHODS

Prospective direct observational study.

SETTING

Inpatient wards at an academic tertiary care children's hospital.

PARTICIPANTS

Pediatric interns.

RESULTS

Trainees were asked 2.6 questions/hour (interquartile range: 1.4–4.7); most involved medications (28%), general care plans (27%), diagnostic tests/procedures (22%), diet/fluids (15%), and physical exams (9%). Interns reported using information provided in written or verbal handoffs to answer 32.6% questions (written 7.3%; verbal 25.3%). Other resources utilized included general medical knowledge, the medical record, and parental report. Questions pertaining to diet/fluids were associated with increased written handoff use (odds ratio [OR]: 3.64, 95% confidence interval [CI]: 1.51–8.76), whereas having worked more consecutive nights was associated with decreased written handoff use (OR: 0.29, 95% CI: 0.09–0.93). Questions regarding general care plans (OR: 2.07, 95% CI: 1.13–3.78), those asked by clinical staff (OR: 1.95, 95% CI: 1.04–3.66), and questions asked of patients with longer lengths of stay (OR: 1.97, 95% CI: 1.02–3.80) were predictive of verbal handoff use.

CONCLUSIONS

Pediatric housestaff face frequent questions during overnight shifts and frequently use information received during handoffs to provide answers. A better understanding of how handoffs and other resources are utilized by housestaff could inform future targeted initiatives to improve trainees' access to key information at night. Journal of Hospital Medicine 2013;8:328–333. © 2013 Society of Hospital Medicine