Article Text

Download PDFPDF
Characterising physician listening behaviour during hospitalist handoffs using the HEAR checklist
  1. Elizabeth A Greenstein1,
  2. Vineet M Arora2,
  3. Paul G Staisiunas2,
  4. Stacy S Banerjee3,
  5. Jeanne M Farnan4
  1. 1Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
  2. 2Department of Medicine, Section of General Medicine, University of Chicago, Chicago, Illinois, USA
  3. 3Department of Medicine, Section of Hospital Medicine, University of Michigan, Chicago, Illinois, USA
  4. 4Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Jeanne M Farnan, Department of Medicine, Section of Hospital Medicine, University of Chicago, 5841 S. Maryland Ave., MC 2007, AMB W216, Chicago, IL 60637, USA; jfarnan{at}


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.

  • Transitions in care
  • Patient safety
  • Communication
  • Hospital medicine
  • Checklists

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.