Current Handoff Research Articles

Evaluating the Safety and Quality of Intraoperative Anesthesia Handoffs from the Perspective of Anesthesia Providers

Handoffs, that is, care transitions, convey information, responsibility, and authority between care providers. Intraoperative handoffs, which occur during surgery either due to shift changes or breaks, are high-risk, error-prone and linked with inadequate verbal communication and documentation. We explored perspectives about safety and quality of intraoperative handoffs between anesthesia providers at an academic medical center. Through an anonymous online survey, we asked participants to share their opinions on current handoff practices including teamwork, staffing and work pace, and handoffs and information exchange. The results showed positive perceptions about teamwork, while only half of the participants were positive about staffing and work pace. We also found that opinions of participants about staffing and work pace vary based on their role. Our study emphasizes the importance of considering diverse perspectives and employing a systems-based approach to address challenges and implement effective interventions for safe, high-quality handoffs in intraoperative care.

Evaluation of Handoff Drop Call Rate in GSM Network in Delta State with Dynamic Cut off Channel Allocation Scheme

This study aims at evaluating Handoff drop call rate in GSM Network using dynamic Cut off Channel Allocation Scheme by evaluating different Mobile Network Operators, MNOs, and comparing with Nigerian Communication Commission (NCC)’s Key Performance Indicator (KPI). A hybrid handoff algorithm was developed to reduce drop calls, analyze the performance of the hybridized handoff algorithm; and compare the simulated results of the hybridized algorithm with that of the existing Mobile network operators, MNOs. The current handoff failure and drop call rates of the best mobile communication network in Nigeria was evaluated and was discovered that the existing Hand off failure rate HFR per cell was 5% and the drop call rate DCR was 10%. These were above the NCC maximum target of 2%. These defects account for the unacceptable drop call rates experienced and thus negatively impact on the quality of service QoS. An optimal solution was provided by developing an enhanced and highly sensitive handoff algorithm from two different algorithms - the Entire Channel Allocation, and the Fixed Channel Allocation - while putting the Modified Reserved Channel Scheme with Guard Channel, and the Fuzzy handoff initiation method into consideration. A software known as Netbeans 7.2 was interfaced with Octave 5.1.0 and used to simulate the developed algorithm. The programme trial was made to run repeatedly for 1200s. Our simulation results indicated HFR of 3% as against 5% from that of the existing network, and DCR of 6% as against the 10% from the network. In further comparing the existing DCR with that obtained from our simulation, an average of 40% dropped calls reduction was realized. This implied that the algorithm reduced drop calls thereby enhancing connectivity and mobility management through the minimization of handoff failures.

Improving Electronic Patient Handoff in an Orthopedic Residency using the Listrunner© Application.

IntroductionMiscommunication during shift change and other handoff events is a common source of malpractice claims and patient-care errors. An efficient patient handoff system is imperative to prevent miscommunication. Owning to limitations with our current handoff system and to an ever-increasing reliance on electronic health information, our residency program sought to modernize our handoff method.MethodsTo improve handoff communication, the HIPAA-compliant application Listrunner© was adopted. Members of the orthopaedic trauma team were oriented to the new application. Change-of-shift patient handoff was transitioned from the current email system to List-runner©. After three months of using the new application, a web-based questionnaire was administered to all members of the care team to assess their experiences, including perceived benefits and limitations of the Listrunner© application.ResultsSeventeen orthopaedic resident physicians and three orthopaedic trauma attending physicians completed the survey. While almost half of the respondents were satisfied using email as a checkout tool, more than half of study participants indicated that it lacked security and several users believed there was a need for improvement. Most indicated that Listrunner© was easy to use, improved clinical efficiency, and improved patient care and safety. Seventeen of 20 respondents reported that they would like to continue using Listrunner© as a check-out tool.ConclusionsThe Listrunner© application was adopted quickly by our orthopaedic trauma team, whose members opined that the application increased the efficiency and accuracy of handoff when compared to the previous secure email system.

Towards a fast and stable filter for RSSI-based handoff algorithms in dense indoor WLANs

In dense indoor wireless networks, handoffs occur frequently. The criteria to trigger handoffs are not defined by the IEEE 802.11 standard, thus being specific to each manufacturer’s implementation. Current handoff implementations typically use RSSI (Received Signal Strength Indicator) as a performance metric and commonly cause association instability in dense environments, a well-known problem referred to as the ping-pong effect. In this paper, we present a deep analysis of RSSI traces collected in dense indoor environments using the FIBRE testbed. Based on that, we conclude that the RSSI time series presents deep fast fades that occur frequently in bursts of small sizes, which can cause ping-pongs. Motivated by this behavior, we propose a new and simple filtering mechanism called Maximum which targets to eliminate these valleys in the RSSI time series. In a nutshell, this filter chooses the maximum RSSI value from a sliding window containing the last few RSSI samples of the series. We conduct simulations based on real RSSI traces from static and mobile scenarios to evaluate Maximum with respect to other filtering mechanisms found in the literature. Additionally, we present a simplified model of the behavior of Maximum that allows us to study the probability of unwanted handoffs as a function of the RSSI of the available access points. Our analysis reveals that Maximum is able to offer a better tradeoff between handoff triggering delay and stability in mobile scenarios, while also performing well in static scenarios, effectively avoiding the occurrence of ping-pongs in most cases.

Organizational climate for safe and effective inter-unit handoffs in Japanese hospitals.

To extract the organizational climate factors that contribute to safe and effective inter-unit patient handoffs, as well as to capture their crucial characteristics in the context of current Japanese hospitals. A questionnaire survey was conducted among nursing staff in 31 general hospitals, collecting a total of 5117 valid responses (69% response rate). A five-factor model was established to determine the inter-unit handoff climate within hospitals. This comprised information and responsibility-related risk, role understanding, communication, handoff environment, and guidelines and process. Based on nursing staff perceptions, the inter-unit handoff climate in Japanese hospitals were generally found to be moderate or moderate-to-high levels across all five of the factors. Nursing staff's perceptions of all five climate factors differed significantly across hospitals and work units, rather than working conditions (full-time vs. part-time) or professions (nurse vs. nurse assistant). All five handoff factors were verified their significant impacts on patient safety awareness and handoff quality. Furthermore, in hospitals where staff perceptions of handoff climate were more positive, information was transferred more effectively. An inter-unit handoff climate structure was extracted and verified its impact on handoff quality and safety. Due to moderate climate levels in Japanese hospitals, as well as background factors such as low risk awareness among staff and busy situations, promoting a more positive organizational culture is suggested for creating safer and more effective inter-unit handoffs. Improving the current handoff guidelines and processes in hospitals and using non-licensed assistive staff more effectively are also recommended.

Patient safety culture and handoff evaluation of nurses in small and medium-sized hospitals

ObjectivesThis study was conducted to investigate the current status of handoffs, perception of patient safety culture, and degrees of handoff evaluation in small and medium-sized hospitals and identified factors that make a difference in handoff evaluation. MethodsThis is a descriptive study. 425 nurses who work at small and medium-sized hospitals in South Korea were included in our study. They completed a set of self-reporting questionnaires that evaluated demographic data, handoff-related characteristics, perception of patient safety culture, and handoff evaluation. ResultsResults showed that the overall score of awareness of a patient safety culture was 3.65 ± 0.45, the level was moderate. The score of handoff evaluation was 5.24 ± 0.85. Most nurses experienced errors in handoff and most nurses had no guidelines and checklist in the ward. Handoff evaluation differed significantly according to the level of education, work patterns, duration of hospital employment, handoff method, degree of satisfaction with the current handoff method, errors occurring at the time of handoff, handoff guidelines, and appropriateness of handoff education time (P < 0.05). ConclusionFor handoff improvement, guidelines and standards should be established. It is necessary to develop a structured handoff education system. And formal handoff education should be implemented to spread knowledge uniformly.

Inter-shift handoff: Changes over a 6-year interval.

To capture inter-shift handoff changes over a 6-year interval and to verify whether the handoff supporting system and aids (e.g., guidelines, training, and protocols) and environment really affect handoff performance. A non-experimental cross-sectional research design. Data from the 2017 and 2011 surveys were used for comparisons. A questionnaire survey was conducted among nursing staff in 31 general hospitals in 2017 and 4,282 staff responses were collected from inpatient wards such as internal medicine and surgery, the intensive care unit, emergency department and operating room. These were compared with the 1,182 responses collected in the previous 2011 survey. Changes in the 6-year interval included the introduction of handoff guidelines and increased provision of training. The handoff approach changed significantly and relied more on electronic systems, especially in inpatient wards. However, there was no significant improvement in interruptions. Information transfer improvement was limited and only observed in the surgery wards. Significant correlations verified that in hospitals where nursing staff more positively evaluated the effectiveness of the guidelines, faced fewer interruptions and had more time, handoff performance was better overall, and a higher frequency of sufficient information transfer was evident. Although the inter-shift handoff supporting system had great changes, improvement of information transfer occurred only in the surgery wards and was limited. It was verified that more effective handoff guidelines and a better handoff environment contributed significantly to improving inter-shift handoff performance. This study addressed the question as to whether inter-shift handoffs have really improved. The answer is yes, but in a limited way. Based on the survey results and handoff practices in Japanese hospitals, a mixed approach (verbal, written, technological) is suggested for inter-shift handoffs. In addition, it is important to improve the current handoff procedures, guidelines and training.

Probability-Based Centralized Device for Spectrum Handoff in Cognitive Radio Networks

Wireless communication technology is the future of communication, but rapid growth in wireless technology has led to a scarcity in the spectrum. Thus, the world has moved away from fixed spectrum allocation to dynamic spectrum allocation. Cognitive radio technology is a rapidly growing technique that allows spectrum to be shared between licensed or primary users (PUs) and unlicensed or secondary users (SUs). The SUs are allowed to use the licensed channels in the absence of the PUs. Upon the arrival of a PU on the channel, the SU has to leave the channel and resume its transmission on another channel. This process is known as spectrum mobility, and the shift in the channel is known as spectrum handoff. Typical transmission of data using this technology requires numerous spectrum handoffs, leading to fluctuations in the spectrum allotted to SUs. Reducing the number of handoffs and providing SUs with a better transmission environment require choosing an efficient handoff strategy. The current handoff strategies face various drawbacks that reduce the efficiency of the network. This paper presents a probability-based centralized device for increasing the efficiency of spectrum handoffs in cognitive radio networks. The handoff strategy presented in this paper improves the accuracy in sensing the right channel for handoff, reduces the energy consumed in the process, reduces the handoff time, and speeds up the transmission of data. This paper presents a complete model of the system, along with the detailed study of its parameters that proves the effectiveness of the technique.

Implementation of a low-cost standardized handoff system (IPASS) in a pediatric hematology/oncology unit: Lessons from a low-middle income country.

278 Background: Communication failure is the most common preventable cause of medical adverse event, and almost half of all sentinel events involve handoff failure. Inefficient handoff is labor intensive and time consuming, impacting the quality of patient care provided. A safe and efficient means of exchange of medical information between care teams via a standardized handoff system is essential, especially in high intensity fields such as Pediatric Hematology/Oncology. Methods: Pre-intervention, handoff entailed the physical handover of handwritten notes, carbon copied for various team members. A standardized electronic handoff tool (IPASS) was identified, and significantly modified to fit our needs, since we do not have a complete electronic medical record (EMR). Microsoft Sharepoint (Microsoft, Redmond, WA) was used to develop a tabulated online portal incorporating patient demographic, clinical and laboratory details with physician remarks. This allowed remote access, multiple simultaneous inputs, authenticated use and user-specific access control. Implementation included sensitizing residents to the IPASS template, hands-on training, weekly feedback from the residents, directly observed hand-off by the chief and/or senior resident. Following a four-week pilot this was expanded to other sub specialties, and a pre and post intervention survey was conducted to assess its impact. Results: Pre-implementation survey revealed 74% resident and 87% faculty dissatisfaction with the current handoff process. Weekly compliance audits after initial pilot demonstrated a 100% compliance. Post-Implementation results showed that the resident dissatisfaction has gone down to less than 5%. Conclusions: Implementation of an electronic handoff tool in the absence of an EMR with minimal resources is a major breakthrough and can be replicated in other low-resource settings. We successfully implemented IPASS without any added infrastructure cost. In the next phase of our project we will be measuring trends in reduction in medical errors since implementation.

Developing Standardized “Receiver-Driven” Handoffs Between Referring Providers and the Emergency Department: Results of a Multidisciplinary Needs Assessment

Miscommunication during patient transfers is a leading cause of medical errors. Inpatient standardization of handoff communication has been associated with reduced medical errors, but less is known about best practices for handoffs from referring providers to the emergency department (ED). The study aims were to identify (1) stakeholder perceptions of current handoff processes and (2) key handoff elements and strategies to optimize patient care on transfer. A mixed-methods needs assessment study was conducted at a tertiary care children's hospital with a communication center that receives verbal handoff via telephone from referring providers and provides written summary to the ED. ED, primary care providers, and communication center staff were surveyed to understand perceptions of handoff processes and ideal handoff elements. Focus groups were conducted to refine concepts. Descriptive statistics, chi-square analysis, and qualitative content analysis were used to analyze responses. The survey response rate was 129/152 providers (85%). Forty-two percent of respondents described the quality of the handoff process as "very good" or "excellent"; 43% reported miscommunication occurring "sometimes" or "frequently." Within the I-PASS framework-Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver-respondents identified 10 key elements to obtain through a receiver-driven process to optimize care on transfer. Free-text responses revealed a perceived need to standardize communication. A minority of providers perceived handoff quality between outpatient practices and the ED as "very good" or "excellent"; almost half perceived regular miscommunication. A receiver-driven process is a novel approach that may help ensure standardized communication of key handoff elements in this context.

I-PASS Mentored Implementation Handoff Curriculum: Implementation Guide and Resources.

Communication failures during shift-to-shift handoffs of patient care have been identified as a leading cause of adverse events in health care institutions. The I-PASS Handoff Program is a comprehensive handoff program that has been shown to decrease rates of medical errors and adverse events. As part of the spread and adaptation of this program, a comprehensive implementation guide was created to assist individuals in the implementation process. The I-PASS Mentored Implementation Guide grew out of materials created for the original I-PASS Study, Society of Hospital Medicine (SHM) mentored implementation programs, and the experience of members of the I-PASS Study Group. The guide provides a comprehensive framework of all elements required to implement the large-scale I-PASS Handoff Program and contains detailed information on generating institutional support, training activities, a campaign, measuring impact, and sustaining the program. Thirty-two sites across North America utilized the guide as part of the SHM program. The guide served as a main reference for 477 hours of mentoring phone calls between site leads and their mentors. Postprogram surveys from wave 2 sites revealed that 85% (N = 34) of respondents felt the quality of the guide was very good/excellent. Site leads noted that they referenced the guide most often during the early part of the program and that they referenced the sections on the curriculum and handoff observations most often. The I-PASS Mentored Implementation Guide is an essential resource for those looking to implement the large-scale I-PASS Handoff Program at their institution.

Nurses' handoff and patient safety culture in perinatal care units

To examine nursing handoff, identify causes of handoff errors, evaluate current methods of handoff and determine the factors associated with handoff evaluation in delivery rooms and neonatal units of hospitals in South Korea. Handoff is a critical communication process in clinical settings. Less attention has been paid to the handoff practice to assure safe perinatal care in hospitals. This is a cross-sectional descriptive study. A total of 291 nurses participated in the study. They completed a set of self-reporting questionnaires containing five instruments that evaluated demographic data and current handoff strategies, experience of handoff error, causes of handoff error, perception of patient safety culture and handoff evaluation. The responses were analysed using descriptive statistics and stepwise regression modelling. Perception of patient safety culture was positively related to handoff evaluation, while experience and causes of handoff error were negatively related to handoff evaluation. A regression analysis showed that degree of cooperation among departments and units, reasonable communication and processes, and frequency of reported medical errors were positively related to handoff evaluation and the lack of documented guidelines or checklists was negatively associated with handoff evaluation. This study suggests that hospitals should develop a standardised handoff checklist according to documented guidelines, promote cooperation among hospital units and departments, enhance communication and clarify work processes to achieve safer care to create an affirmative culture that encourages reporting of errors to keep patients safe. This study highlights the importance of standardising handoff process and systems, promoting communication and cooperating with each other to foster patient safety culture in perinatal care units.

Formalizing Radiation Oncology Patient Handoff: The GRAY System

Effective transitions of care are vital to patient safety and treatment quality. Inpatient services, which have multiple provider changes daily, have implemented formal patient handoff systems in recent years. However, these systems do not address transition of care issues in Radiation Oncology, where residents typically manage a cohort of patients for several months before handing off to an oncoming resident. Thus, we surveyed and propose a specific method for patient handoff in Radiation Oncology: The GRAY System (General, Review Status, Active Issues, Your Questions?). A survey with questions tailored to understanding current handoff practices in residency programs was distributed to radiation oncology residents and program directors nationwide. Responses were recorded anonymously and used to create a novel handoff system that incorporates the unique demands of the field. 74 surveys were collected from trainees (PGY 2-6) as well as three residency program directors. All respondents answered that a typical rotation at their program was 2-3 months. Use of some form of patient handoff at the end of rotations was reported by 58% (n=42) of respondents. All use an electronic medical record (EMR). When asked how important a formalized process is in Radiation Oncology on a scale of 1-5 (1=least, 5=most), 73% (n=54) answered 3 or higher. Deficient patient handoff was reported to cause issues with patient care according to 42% (n=31), and several (n=16) estimated at least 25% of patients were at risk for care lapses. In a free response question asking what factors were most important for effective handoff, common responses included dedicated sign-out time, concise patient summaries, and a list of pertinent patient issues that may affect treatment. Despite the majority of respondents answering that a formalized transition of care process is important in radiation oncology, only about half of respondents reported utilizing it with an estimated ¼ of patients at risk for care lapses. Because of these deficiencies and the drive towards patient safety and quality, we propose the GRAY System to formalize the patient handoff process in Radiation Oncology. “General” will include a one-sentence summary of patient details (age, sex, stage, histology, location, treatment technique, and prescribed or expected dose/fractionation). “Review status” describes the patient’s status in the treatment process (upcoming CT sim with date, in Physics/Dosimetry for planning, treatment #x/y, and expected end of treatment date). “Active issues” will include a concise list of active patient issues (comorbidities, social issues, labs, treatment breaks, impending boost planning). “Your questions?” will prompt the handoff receiver to ask any questions. We anticipate the GRAY system may streamline patient handoff, reduce the likelihood of care lapses, and provide easily traceable data for future analyses.

Improving cancer treatment handoffs: Wilmot Cancer Institute’s (WCI) ASCO Quality Training Program experience.

139 Background: Ineffective handoffs contribute to gaps in patient care and medication errors, jeopardizing patient safety and leading to poor quality of care. Ineffective handoffs accounted for 59% of reported medication events at WCI Infusion Center. The completion rate of WCI’s existing electronic medical record (EMR) based free text handoff note for patients treated with anti-cancer therapy on the same day as a clinic visit was 32%. The project aim is to create an effective EMR integrated treatment handoff tool and establish standard workflow processes to ensure optimal communication among WCI providers for improved patient safety and quality of care. Methods: We convened a multidisciplinary team to develop an efficient and safe treatment handoff tool. WCI nurses were surveyed to evaluate the baseline state of the handoff process. Tool development was performed over a series of phases, including creation of a project charter and aim statement, outlining current workflow process, identifying gaps and limitations in the process, identifying potential causes of ineffective hand-off and using a Pareto chart to prioritize them. Utilizing the Situation-Background-Assessment-Recommendation framework, an EMR-integrated handoff tool with standardized workflow process was developed, along with an educational plan for the tool. Results: 52% (N = 22/42) of nurses found the current handoff note to be ineffective at preventing errors and 48% (N = 20/42) identified incomplete or missing information as a significant factor for ineffective communication. Other barriers identified included poor note design, lack of standardization in workflow and variation in note use. During the 1 week implementation of the new handoff tool, the utilization rate was 100% (N = 32) with completion rate of 41% (13 of 32). Further data collection is ongoing and nursing perception of the new tool will be evaluated at 3 months. Conclusions: Multidisciplinary stakeholders’ guided development and implementation of an EMR-integrated treatment handoff tool to optimize the communication between cancer care providers during patient transition is associated with improvement in handoff tool utilization and communication.

Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm.

IntroductionWe aimed to assess the current scope of handoff education and practice among resident physicians in academic centers and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED) to an inpatient setting.MethodsThis was a cross-sectional survey targeted at the program directors, associate or assistant program directors, and faculty members of emergency medicine (EM) residency programs in the United States (U.S.). The web-based survey was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff.Results121 of 172 programs responded to the survey for an overall response rate of 70.3%. Our survey showed that most EM programs in the U.S. have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system, over 70% of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess the handoff proficiency of trainees. Handoffs most commonly take place over the phone, though respondents disagree about the ideal place for a handoff to occur, with nearly equivalent responses between programs favoring the bedside over the phone or face-to-face on a computer. Approximately two-thirds of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and on the review of the literature, we developed a five-step algorithm for the transition of care from the ED to the inpatient setting.ConclusionOur results identified the current trends of education and practice in transitions of care, from the ED to the inpatient setting in U.S. academic medical centers. An algorithm, which guides this process, is proposed to address the current gap in the standardized approach to ED to inpatient handoffs that were identified in the survey’s assessment of needs.

Evaluating handoffs in the context of a communication framework

The implementation of mandated restrictions in resident duty hours has led to increased handoffs for patient care and thus more opportunities for errors during transitions of care. Much of the current handoff literature is empiric, with experts recommending the study of handoffs within an established framework. A prospective, single-institution study was conducted evaluating the process of handoffs for the care of surgical patients in the context of a published communication framework. Evaluation tools for the source, receiver, and observer were developed to identify factors impacting the handoff process, and inter-rater correlations were assessed. Data analysis was generated with Pearson/Spearman correlations and multivariate linear regressions. Rater consistency was assessed with intraclass correlations. A total of 126 handoffs were observed. Evaluations were completed by 1 observer (N=126), 2 observers (N=23), 2 receivers (N=39), 1 receiver (N=82), and 1 source (N=78). An average (±standard deviation) service handoff included 9.2 (±4.6) patients, lasted 9.1 (±5.4) minutes, and had 4.7 (±3.4) distractions recorded by the observer. The source and receiver(s) recognized distractions in >67% of handoffs, with the most common internal and external distractions being fatigue (60% of handoffs) and extraneous staff entering/exiting the room (31%), respectively. Teams with more patients spent less time per individual patient handoff (r=-0.298; P=.001). Statistically significant intraclass correlations (P≤.05) were moderate between observers (r≥0.4) but not receivers (r<0.4). Intraclass correlation values between different types of raters were inconsistent (P>.05). The quality of the handoff process was affected negatively by presence of active electronic devices (β=-0.565; P=.005), number of teaching discussions (β=-0.417; P=.048), and a sense of hierarchy between source and receiver (β=-0.309; P=.002). Studying the handoff process within an established framework highlights factors that impair communication. Internal and external distractions are common during handoffs and along with the working relationship between the source and receiver impact the quality of the handoff process. This information allows further study and targeted interventions of the handoff process to improve overall effectiveness and patient safety of the handoff.

Korean nurses’ perspectives regarding handoffs

Background: Nursing handoffs are communicative routines in most nursing units. The handoff is critical to the continuity and safety of patient care. Negative perceptions of handoffs could hinder efficient communication between nurses. Aims: This study identified the perceptions of nurses’ handoffs in Korea. Design: A descriptive survey was employed. The population included nurses who worked in a general ward in 201 hospitals with more than 300 beds. Results: 27.9% responded that the current handoff method needed to be changed and 75.8% had no handoff-related guideline. “Handoffs are frequently interrupted by outsiders’ visits” was the most frequent problem expressed. Variables associated with a perceived need for change in handoff methods were age, handoff method, and preparation time for handoffs. Conclusion: Nurses recognized that handoffs were frequently interrupted by external factors and consumed too much time. Therefore, a standardized handoff method is needed to ensure the accuracy of information.

P065: Surveying ED transition of care: satisfaction, awareness of risks and barriers to the implementation of a standardized protocol

Introduction: Patient handoffs have been identified as the primary cause of error affecting patient safety. The lack of standardization - and the often-avoidable errors that occur as a result - profoundly affect patient care and emergency department (ED) administration. Our study set out to evaluate emergency doctors’ awareness of these safety concerns, as well as their satisfaction with handoff practices currently used in their respective EDs. We also aimed to identify the potential barriers to the use of a standardized approach to patient transition of care. Methods: Guided by a modified Delphi method, a 29-question survey was developed by a panel of experts on patient transition of care. A printed version of the survey was distributed to ED doctors attending a local emergency medicine conference. An electronic version was subsequently distributed to all ED doctors registered as members of our provincial professional organizations. Results: We achieved a 68% response rate. Amongst the 309 participants, 51% (95%CI 44-56%) acknowledged that handoffs between emergency doctors are a frequent cause of error related to patient care. Frequent interruptions (77% (95%CI 72-82%)) and heavy workloads (73% (95%CI 68-79%)) were identified as the main factors negatively influencing the quality of handoffs. Despite 61% (95%CI 56-68%) satisfaction with the currently employed methods, 74% (95%CI 68-79%) of the respondents believe that handoffs would benefit from standardization and 83% (95%CI 79-88%) are open to changing their current practices. In addition, 53% (95%CI 48-60%) believe that the tools used for transition of care can be improved. Apprehension regarding the increase of handoff burden (86% (95%CI 81-90%)) was identified as the primary barrier to the implementation of a standardized handoff protocol. Conclusion: Doctors are generally satisfied with current handoff practices used in the ED. Nevertheless, their awareness of the possible risks associated with transition of care may be driving their openness to adapting their practice, potentially towards a more standardized approach given the conceivable benefits to patient safety. In light of these results, we aim to develop a comprehensive, standardized handoff protocol, and to evaluate its applicability in the ED with a prospective study.

ICU Attending Handoff Practices: Results From a National Survey of Academic Intensivists.

To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs. Cross-sectional electronic survey administered in 2014. One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education. Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists. None. Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (SD, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs. ICU attending handoffs in the United States exhibit marked heterogeneity, and intensivists do not agree about the value of attending handoffs. In addition, some intensivists perceive a link between suboptimal attending handoffs, inappropriate treatment, and serious adverse events that warrants further study.

Integrated Multi-service Handoff Mechanism with QoS-Support Strategy in Mobile Cloud Computing

Mobile devices are becoming the primary platforms for many users who always roam around and access the cloud computing applications. Using cloud computing services extensively and offloading local applications to the cloud, facilitate mobile devices keep multiple services online at the same time. Since the mobile device may move fast and session handoff among access networks comes up frequently, multiple services initiate handoff procedure results in lots of redundant signaling. The current handoff mechanisms only make the handoff control for each service individually, which brings much unnecessary energy consumption and ignores the different Quality of Service (QoS) requirement during handoff execution. To solve these issues, we propose an improved multi-services handoff mechanism, which uses the list method of session initial protocol to make all active services execute handoff together. And considering to support the QoS for each active service during handoff procedure, the differentiate policy for multi-service media transfer is included based on the integrated handoff signaling. Analytic model and simulation are developed to investigate the new mechanism. The results demonstrate that the improved multi-service handoff mechanism can efficiently save energy consumption for mobile devices and realize seamless handoff.