Answering questions on call: pediatric resident physicians' use of handoffs and other resources

J Hosp Med. 2013 Jun;8(6):328-33. doi: 10.1002/jhm.2038. Epub 2013 Apr 16.


Background: Little is known in the literature about the types of questions being asked of on-call housestaff and the resources used to provide answers.

Objective: To characterize questions being asked of pediatric interns on call and evaluate their use of written handoffs, verbal handoffs, and other resources.

Design/methods: Prospective direct observational study.

Setting: Inpatient wards at an academic tertiary care children's hospital.

Participants: Pediatric interns.

Results: Trainees were asked 2.6 questions/hour (interquartile range: 1.4-4.7); most involved medications (28%), general care plans (27%), diagnostic tests/procedures (22%), diet/fluids (15%), and physical exams (9%). Interns reported using information provided in written or verbal handoffs to answer 32.6% questions (written 7.3%; verbal 25.3%). Other resources utilized included general medical knowledge, the medical record, and parental report. Questions pertaining to diet/fluids were associated with increased written handoff use (odds ratio [OR]: 3.64, 95% confidence interval [CI]: 1.51-8.76), whereas having worked more consecutive nights was associated with decreased written handoff use (OR: 0.29, 95% CI: 0.09-0.93). Questions regarding general care plans (OR: 2.07, 95% CI: 1.13-3.78), those asked by clinical staff (OR: 1.95, 95% CI: 1.04-3.66), and questions asked of patients with longer lengths of stay (OR: 1.97, 95% CI: 1.02-3.80) were predictive of verbal handoff use.

Conclusions: Pediatric housestaff face frequent questions during overnight shifts and frequently use information received during handoffs to provide answers. A better understanding of how handoffs and other resources are utilized by housestaff could inform future targeted initiatives to improve trainees' access to key information at night.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence*
  • Female
  • Health Resources / statistics & numerical data*
  • Humans
  • Internship and Residency / methods*
  • Male
  • Patient Handoff / statistics & numerical data*
  • Pediatrics / methods*
  • Prospective Studies