Characterising physician listening behaviour during hospitalist handoffs using the HEAR checklist

BMJ Qual Saf. 2013 Mar;22(3):203-9. doi: 10.1136/bmjqs-2012-001138. Epub 2012 Dec 20.


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<0.01). Read-back occurred only eight times (17%). In 11 handoffs (23%) receivers took notes. Almost all (98%) handoffs were interrupted at least once, most often by side conversations, pagers going off, or clinicians arriving. Handoffs with more patients, such as service change, were associated with more interruptions (r=0.46, p<0.01).

Conclusions: Using the 'HEAR Checklist', we can characterise hospitalist handoff listening behaviours. While passive listening behaviours are common, active listening behaviours that promote memory retention are rare. Handoffs are often interrupted, most commonly by side conversations. Future handoff improvement efforts should focus on augmenting listening and minimising interruptions.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Auditory Perception*
  • Checklist / statistics & numerical data*
  • Chicago
  • Continuity of Patient Care / organization & administration
  • Dichotic Listening Tests
  • Documentation
  • Health Knowledge, Attitudes, Practice
  • Hospitalists / psychology*
  • Hospitalists / statistics & numerical data
  • Humans
  • Observer Variation
  • Patient Handoff / standards*
  • Patient Handoff / statistics & numerical data
  • Process Assessment, Health Care / methods*
  • Process Assessment, Health Care / statistics & numerical data
  • Prospective Studies
  • Time Factors