Key result
Pediatric interns faced 2.6 questions per hour on call, using written or verbal handoffs to answer 32.6% of questions, with diet/fluid questions predicting increased written handoff use (OR 3.64).
Observational
No
Pediatric interns frequently rely on written and verbal handoffs to answer questions during overnight shifts, highlighting the importance of effective handoff communication.
Handoff reliance for one-third of overnight questions may warrant training focus in pediatrics; hypothesis-generating for targeted interventions on high-burden queries.
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.
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McSweeney et al. (2013) conducted an observational in Pediatric interns on call. Written and verbal handoffs vs. Other resources (general medical knowledge, medical record, parental report) was evaluated on Types of questions asked and resources used to provide answers. Pediatric interns faced 2.6 questions per hour on call, using written or verbal handoffs to answer 32.6% of questions, with diet/fluid questions predicting increased written handoff use (OR 3.64).
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