Omitted Diagnostic Information
Three physician shift transitions (compared to two) in a busy community emergency department are most likely to result in omitted diagnostic information during handoffs. This reflects the well-established principle that each additional care transition introduces new opportunities for communication breakdowns and information loss.
Why More Handoffs Increase Information Loss
Multiple guidelines consistently identify handoffs as high-risk events for communication failures:
Each transition point represents a potential breakdown in communication, with causes including inadequate time for handoffs, lack of standardized procedures, and differences in expectations between sending and receiving providers 1.
Communication errors are particularly common in the ED environment due to numerous handoffs between multiple healthcare professionals, frequent verbal orders during emergencies, and the chaotic nature of shift work 1.
Ineffective care transition processes directly result in adverse events, including information gaps that compromise patient safety 1.
The Multiplicative Risk of Additional Transitions
The evidence demonstrates that transitions are inherently problematic:
Breakdowns in communication, patient education, and accountability occur at each transition point, with the risk compounding as the number of handoffs increases 1.
Standardized handoff procedures are often lacking, with only 10.9% of emergency medicine residents and 9.0% of nurses reporting receipt of structured handoff training 2.
Assessment of handoff proficiency is rarely conducted, with 93.9% of emergency medicine academic chairpersons stating such assessments were not performed in their programs 2.
Why Other Options Are Less Likely
Improved situational awareness and workflow efficiency would paradoxically worsen with more handoffs, not improve, as each transition requires time for information transfer and creates opportunities for miscommunication 1, 2.
Reduced length of stay is not directly influenced by the number of physician shift transitions; length of stay is primarily determined by patient acuity, diagnostic workup requirements, and disposition planning rather than handoff frequency 3.
Critical Safeguards When Multiple Handoffs Are Unavoidable
When three-shift systems are necessary, implement these protective measures:
Use electronic health record "rounding lists" that automatically populate to reduce human error during hospital-based transitions 1, 3.
Ensure uninterrupted time and space for handoffs, with specific identification of high-risk patients requiring special attention 2.
Provide structured handoff training for all ED staff, as the vast majority currently lack formal education in this critical skill 2.
Implement standardized handoff algorithms that include setting the stage, assembling the team, identifying high-risk patients, conducting shift sign-out, and closing the loop 2.