Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures.
Twenty-three children’s hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction.
Twenty-three children’s hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]).
Implementation of a standardized evidence-based handoff process across 23 children’s hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction.
Comments
Interventions to teach handoffs need to fit the 80 hour work-week
We read the article on handoffs using the I-PASS method by Bigham et al in the most recent issue of Pediatrics in which they showed improvement in resident performance over time. We have been doing work in the same area with medical students and have shown that we can increase students' performance initially after a brief one hour intervention and more importantly, that performance improvement persisted 6-12 months later as compared to controls. Whereas the current article does not indicate the length of the intervention at different sites, we would suggest that an intervention that lasts no longer than one hour is compatible with the 80 hour work- week. Our study accomplished that and our results also persisted well beyond the intervention. Another way to limit the intervention time is to use the flipped classroom or blended learning approach, in which the trainees read selected material outside the workshop, then are 'tested' in the workshop to determine their understanding of the content, and finally the majority of the workshop is spent applying principles to real life situations.
Conflict of Interest:
No competing interests