The Veterans Affairs shift change physician-to-physician handoff project.

BACKGROUND: Few studies on the safety or efficacy of current patient handoff systems exist, and few standardized electronic medical record (EMR)-based handoff tools are available. An EMR handoff tool was designed to provide a standardized approach to handoff communications and improve on previous handoff methods. METHODS: In Phase I, existing handoff methods were analyzed through abstraction of printed handoff sheets and questionnaires of internal medicine residents at Department of Veterans Affairs medical centers (VAMCs). In Phase II, the handoff tool was designed, and the software was tested and revised through user feedback and regular conference calls. Phase III involved postimplementation systematic abstraction of printed handoff sheets and questionnaires of internal medicine residents. Two VAMCs participated in abstraction of printed handoff sheets, with four VAMCs responding to the questionnaires. RESULTS: Handoffs were abstracted for 550 patients at baseline and 413 postimplementation. Improvements were found in consistency of information transfer for all handoff content, including code status, floor location, room number, two types of identifying information, typed format, medication, and allergy lists (p = .01). The 63 and 51 questionnaires completed pre- and postimplementation, respectively, showed improvement in perceptions of ease of use, efficiency, and readability (p < .05) and in perceptions of patient safety and quality (p < .01) without causing omission (p < .01) or commission of information (p = .02). DISCUSSION: This standardized EMR-based handoff software improved data accuracy and content consistency, was well-received by users, and improved perceptions of handoff-related patient safety, quality, and efficiency. A final version of the software was incorporated into the national EMR software program and made available to all VAMCs.

Job satisfaction of physicians with congruent versus incongruent specialty choice.

Choosing a specialty within the occupation of medicine is problematic given the number of available specialty choices. A need exists for the development and modification of inventories to be used to help students with selecting a medical specialty. Furthermore, ratings of job satisfaction, regardless of specialty, are mixed with some physicians regretting choosing medicine as a career. Despite its use in medical specialty counseling, research is lacking regarding the Medical Specialty Preference Inventory (MSPI). We examined the predictive validity of the MSPI and compared job satisfaction of physicians (N=51) whose specialty was correctly (i.e., congruent) versus incorrectly (i.e., incongruent) predicted by the MSPI. The MSPI correctly predicted the specialty for 33%. Congruent physicians had higher job satisfaction than incongruent physicians. Results of this study may help individuals who provide medical specialty counseling or who are involved in designing tools and implementing programs to assist students with medical specialty decision making.