Improving resident handoffs has been at the top of the list for many major healthcare organizations. Where they fall short is knowing specifically which recommended strategy is the most effective.

The Accreditation Council for Graduate Medical Education, Agency for Healthcare Research and Quality, and Joint Commission have all offered ideas for best resident handoff in a paper published in JAMA. By examining program directors' responses to the 2014 Association of Program Directors in Internal Medicine electronic survey, the researchers were measured the implementation of handoff strategies within three domains—properties of verbal handoffs (dedicated time), properties of written handoffs (the use of EHR) and educational resources (didactic lectures).

Of the 234 program respondents measured, 61 percent of program directors were at least somewhat satisfied with the handoff strategies used at their institutions. Implementation rates were highest with dedicated time (67 percent), followed by didactic lectures (64 percent), overlapping shifts (61 percent), ward-based teaching by residents (61 percent) and allowing the receiver access to patient records (60 percent).

“Survey responses from program directors reported large variation in implementation of recommended handoff techniques and educational strategies to teach handoffs in internal medicine training programs, with the most frequent used in only 67 percent,” wrote the authors. “Discordance between low implementation and high program director satisfaction may indicate confusion regarding which practices are best for their setting because of the lack of strong or consistent evidence. Few directors reported interactive workshops, simulation exercises, and faculty-level supervision, which were included in a handoff bundle that demonstrated improved patient safety in a multicenter trial. Also, program directors may want to implement these handoff strategies but face significant barriers, such as an EHR unable to facilitate shift handoffs or lack of local expertise to lead interactive workshops.”