Implementing peer evaluation of handoffs: associations with experience and workload.

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.