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Re-framing continuity of care for this century

¹ Accreditation Council for Graduate Medical Education, Chicago, IL, USA
² Department of Health Management and Policy, College of Public Health, University of Iowa, USA

Correspondence to:
MsI Philibert
Accreditation Council for Graduate Medical Education, 515 North State Street, Suite 2000, Chicago, IL 60610, USA; iphilibert@acgme.org

Keywords: communication failure; doctor-doctor communication; patient sign-out; patient safety; continuity of care

The first 150 words of the full text of this article appear below.

It is widely accepted that "continuity of care" is vital to its quality and safety. The traditional approach to achieving this in the inpatient setting has been to minimize transfers among providers to reduce interruptions in the care process. In recent years the effort to limit duty hours for resident physicians (junior doctors) in the US, UK, and EU has highlighted the fact that continuity of care in teaching hospitals cannot depend on trainees working beyond limits that are advisable from a performance and safety perspective. Changing practice in teaching settings and a general movement toward shift and team based approaches to patient care have thrust into prominence the patient "hand-off" (also referred to as "hand-over," "sign-out," or "sign-over") as the process that enables multiple physicians collectively to ensure continuity and currency of information and care.

Hand-offs occur at many places in the care process. In teaching hospitals . . . [Full text of this article]

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