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BACKGROUND The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education. METHODS Faculty at 2 sites (University of Chicago and Yale University) were recruited to participate in a workshop on handoff education. Video-based scenarios were developed to represent varying levels of performance in the domains of communication, professionalism, and setting. Videos were shown in a random order, and faculty were instructed to use the Handoff Mini-Clinical Examination Exercise (CEX), a paper-based instrument with qualitative anchors defining each level of performance, to rate the handoffs. RESULTS Forty-seven faculty members (14 at site 1; 33 at site 2) participated in the validation workshops, providing a total of 172 observations (of a possible 191 [96%]). Reliability testing revealed a Cronbach α of 0.81 and Kendall coefficient of concordance of 0.59 (>0.6 = high reliability). Faculty were able to reliably distinguish the different levels of performance in each domain in a statistically significant fashion (ie, unsatisfactory professionalism mean 2.42 vs satisfactory professionalism 4.81 vs superior professionalism 6.01, P

BACKGROUND Increasing frequency of shift-to-shift handoffs coupled with regulatory requirements to evaluate handoff quality make a handoff evaluation tool necessary. OBJECTIVE To develop a handoff evaluation tool. DESIGN Tool development. SETTING Two academic medical centers. SUBJECTS Nurse practitioners, medicine housestaff, and hospitalist attendings. INTERVENTION Concurrent peer and external evaluations of shift-to-shift handoffs. MEASUREMENTS The Handoff CEX (clinical evaluation exercise) consists of 6 subdomains and 1 overall assessment, each scored from 1 to 9, where 1 to 3 is unsatisfactory and 7 to 9 is superior. We assessed range of scores, performance among subgroups, internal consistency, and agreement among types of raters. RESULTS We conducted 675 evaluations of 97 unique individuals during 149 handoff sessions. Scores ranged from unsatisfactory to superior in each domain. The highest rated domain for handoff providers was professionalism (median: 8; interquartile range [IQR]: 7–9); the lowest was content (median: 7; IQR: 6–8). Scores at the 2 institutions were similar, and scores did not differ significantly by training level. Spearman correlation coefficients among the CEX subdomains for provider scores ranged from 0.71 to 0.86, except for setting (0.39–0.40). Third-party external evaluators consistently gave lower marks for the same handoff than peer evaluators did. Weighted kappa scores for provider evaluations comparing external evaluators to peers ranged from 0.28 (95% confidence interval [CI]: 0.01, 0.56) for setting to 0.59 (95% CI: 0.38, 0.80) for organization. CONCLUSIONS This handoff evaluation tool was easily used by trainees and attendings, had high internal consistency, and performed similarly across institutions. Because peers consistently provided higher scores than external evaluators, this tool may be most appropriate for external evaluation. Journal of Hospital Medicine 2013;8:191–200. © 2013 Society of Hospital Medicine

To examine the associations between perceived control over sleep, noise levels, sleep duration, and noise complaints in a cohort of hospitalized adults.Prospective cohort study.General medicine ward in an academic medical center.One hundred eighteen hospitalized patients age 50 years and over (mean age, 65 years; 57% female; 67% African American).Sleep duration was measured via wrist actigraphy, and noise levels in patient rooms were measured via sound monitors. Validated questionnaires were used to assess sleep characteristics at baseline and sleep quality for each night. Perceived control over sleep was measured at baseline using the Sleep Self-Efficacy (SSE) scale (range 9-45).The mean SSE score was 32.1 (standard deviation, 9.4), and the median score was 34 (interquartile range, 24-41). Average sleep duration for patients in the hospital was 333 minutes (5.5 hours). Forty-two percent of patients complained of noise disrupting their sleep. Linear regression clustered by subject showed that above median SSE was associated with longer sleep duration (+55 minutes 95% confidence interval [CI]: 14, 97; P = 0.010). This association remained significant after controlling for objective noise levels and patient demographics (+50 minutes 95% CI: 11, 90; P = 0.014). In logistic regression controlling for noise level and patient demographics, those patients with high SSE were 51% less likely to complain of noise disruptions (odds ratio: 0.49; 95% CI: 0.25, 0.96; P = 0.039).Higher perceived control over sleep is associated with longer sleep duration, better sleep quality, and fewer reports of noise disruptions. In addition to noise control, interventions to boost perceived control may improve in-hospital sleep.

Background The increasing fragmentation of healthcare has resulted in more patient handoffs. Many professional groups, including the Accreditation Council on Graduate Medical Education and the Society of Hospital Medicine, have made recommendations for safe and effective handoffs. Despite the two-way nature of handoff communication, the focus of these efforts has largely been on the person giving information. Objective To observe and characterise the listening behaviours of handoff receivers during hospitalist handoffs. Design Prospective observational study of shift change and service change handoffs on a non-teaching hospitalist service at a single academic tertiary care institution. Measurements The ‘HEAR Checklist’, a novel tool created based on review of effective listening behaviours, was used by third party observers to characterise active and passive listening behaviours and interruptions during handoffs. Results In 48 handoffs (25 shift change, 23 service change), active listening behaviours (eg, read-back (17%), note-taking (23%) and reading own copy of the written signout (27%)) occurred less frequently than passive listening behaviours (eg, affirmatory statements (56%) nodding (50%) and eye contact (58%)) (p

BACKGROUND Although peer evaluation can be used to evaluate in-hospital handoffs, few studies have described using this strategy. OBJECTIVE Our objective was to assess feasibility of an online peer handoff evaluation and characterize performance over time among medical interns. DESIGN The design was a prospective cohort study. PATIENTS Subjects were medical interns from residency program rotating at 2 teaching hospitals. MEASUREMENTS Measurements were performance on an end-of-rotation evaluation of giving and receiving handoffs. RESULTS From July 2009 to March 2010, 31 interns completed 60% (172/288) of peer evaluations. Ratings were high across domains (mean, 8.3–8.6). In multivariate regression controlling for evaluator and evaluatee, statistically significant improvements over time were observed for 4 items compared to the first 3 months of the year: 1) communication skills (season 2, +0.34 [95% confidence interval (CI), 0.08-0.60], P = 0.009); 2) listening behavior (season 2, +0.29 [95% CI, 0.04-0.55], P = 0.025); 3) accepting professional responsibility (season 3, +0.37 [95% CI, 0.08-0.65], P = 0.012); and 4) accessing the system (season 2, +0.21 [95% CI, 0.03-0.39], P = 0.023). Ratings were also significantly lower when interns were postcall in written sign-out quality (8.21 vs 8.39, P = 0.008) and accepting feedback (8.25 vs 8.42, P = 0.006). Ratings from a community hospital rotation, with a lower census than the teaching hospital, were significantly higher for overall performance and 7 of 12 domains (P < 0.05 for all). Significant evaluator effects were observed. CONCLUSIONS Although there is evidence of leniency, peer evaluation of handoffs demonstrate increases over time and associations with workload such as postcall status. This suggests the importance of examining how workload impacts handoffs in the future. Journal of Hospital Medicine 2013;8:132–136. © 2012 Society of Hospital Medicine

Despite the importance of sleep for recovery, hospital noise may put patients at risk for sleep loss and its associated negative effects. Objectively measured hospital noise can range as high as 67 dB in the intensive care unit to 42 dB in surgical wards, far from the World Health Organization (WHO) international recommendations of 30 dB for patient rooms.1 Although almost half of Medicare patients report that their hospital rooms were not quiet at night, data to objectively characterize noise levels and sleep in hospitalized adults in medical wards are limited.2 One study that objectively measured sleep and noise among hospitalized adults older than 70 years found no association.3 This study aimed to objectively measure noise and sleep duration in adult medical ward patients.

Vineet M. Arora, MD, MAPP1,5, Kevin L. Chang, BS2, Arshiya Fazal3, Paul G. Staisiunas, BA1, Phyllis C. Zee, MD, PhD4, Kristen L. Knutson, PhD1,5, David O. Meltzer, MD, PhD2, and Eve Van Cauter, PhD1,5 1Department of Medicine, University of Chicago 2Pritzker School of Medicine, University of Chicago 3The College, University of Chicago 4Department of Neurology, Northwestern University 5Sleep, Metabolism and Health Center, University of Chicago