Explore this issue:September 2013
It was the beginning of an overnight shift, and the junior resident was the only one in house. He had been briefed about the group of patients he was responsible for, and one patient—who had a complex cancer and underlying cardiac issues and had just come out of a long surgery—had been prescribed a specific antibiotic following the procedure. But what step would the resident take next, when the patient developed a cardiac arrhythmia due to intraoperative blood loss or fluid shifts at 2 a.m.? Would it be something the junior resident had decided on the fly, or had a senior attending physician already envisioned this possibility and discussed how to respond, hours before?
How well these questions are answered depends on how the patient handoff—the information the day’s group of doctors presented to the overnight shift—went earlier in the shift. The handoff procedure is a crucial part of patient care, and standards to strengthen it were implemented in 2011 by the Accreditation Council for Graduate Medical Education (ACGME). In light of the 2003 resident duty hour restrictions—limiting residents to working 80 hours a week, overnight shifts every third or fourth night and at least 10 hours off between shifts—most people admitted to a medical center for care will be seen by at least two shifts of health care workers as one group takes over for the next.