Current Practice in End-of-Residency Handoffs: A Survey of Internal Medicine–Pediatrics Program Directors

Abstract

Abstract Background End-of-residency outpatient handoffs affect at least 1 million patients per year, yet there is no consensus on best practices. Objective To explore the use of formal systems for end-of-residency clinic handoffs in internal medicine–pediatrics residency (Med-Peds) programs, and their associated categorical internal medicine and pediatrics programs. Methods We surveyed Med-Peds program directors about their programs' system for handing off ambulatory continuity patients. Results Our response rate was 85% (67 of 79 programs). Thirty-one programs (46%) reported having a system for end-of-residency handoffs. Of the 30 that offered detailed information, 22 (73%) formally introduced the program to residents, 12 (40%) standardized the handoff, and 14 (47%) used multiple methods for information exchange, with the electronic health record and oral transfer of information (15 of 30, 50%) the most common. Six programs (20%) indicated they did not offer residents protected time to complete end-of-residency handoffs, and 13 programs (43%) did not identify a specific postgraduate year level for residents to whom patients were handed off. Programs were more likely to have a system for end-of-residency handoffs if another categorical program at their institution also had one (P < .001). Conclusions Fewer than half of responding Med-Peds programs have outpatient handoff systems in place. Inclusion of end-of-residency handoff information in the electronic health record may represent a best practice that has the potential of enhancing continuity and safety of care for patients in resident continuity clinics.