Handoff Procedure Research Articles

Performance Analysis for Producer Mobility in Named Data Networking

The influence of producer mobility on Named Data Networking (NDN) networks in dynamic networking environments is amplified, hence necessitating an escalation in the demand for performance analysis. When producers transition between different sites or nodes relocation, there is a significant increase in packet loss. Consequently, the present work centres on conducting experiments and evaluating producer mobility by utilizing the Hybrid Indirection Method (HIM) to mitigate the effects of signalling cost on the handoff procedure. This study aims to analyse the effects of producer mobility, specifically focusing on two critical factors: handoff signalling cost and packet data ratio. The data gathered from the study provide significant insights into the benefits and challenges related to producer mobility. This research paper comprehensively investigates producer mobility within the network simulator ns3 framework. The findings demonstrate a notable enhancement achieved by the HIM technique, resulting in substantial improvements in handoff signalling cost and packet data ratio.

Patient Handoff Practices at the Epilepsy Centers in the United States: A Survey of the Medical Directors.

Communication failure is one of the most significant causes of medical errors. Providing care to patients with seizures at comprehensive epilepsy centers requires uninterrupted coverage and a multidisciplinary approach. However, handoff practices in these settings have not been comprehensively assessed, and recommendations for their standardization are currently lacking. The aim of this observational study was to define the scope of existing practices for patient handoffs across epilepsy centers in the United States and provide relevant recommendations. A 79-question survey was developed to establish the patterns of transition of care for patients undergoing continuous EEG recording, including the periodicity of handoffs and specifics of the relevant workflow. With permission from the National Association of Epilepsy Centers (NAEC), the survey was distributed to the medical directors of all Level 3 and 4 NAEC-accredited epilepsy centers in the United States. The responses were obtained from 70 institutions yielding a survey response rate of 26%. Of these, more than 77% had established weekly handoff processes for both the epilepsy monitoring unit and continuous EEG (cEEG) monitoring services. However, only 53% and 43% of centers had procedures for daily service transfers for the patients admitted to the epilepsy monitoring unit or the patients undergoing cEEG, respectively. The patterns of handoffs were complex and utilized group handoffs in < 50% of institutions. In most centers (>70%), patient data transmitted through handoffs included history, clinical information, and EEG findings. However, templates were not applied to standardize this information. All participants agreed or strongly agreed that a culture of patient safety was maintained in their place of practice; however, 12% of participants felt that insufficient time was allowed to discuss these patients or carry out the handoffs without interruptions. Existing handoff practices are not uniform or fully established across epilepsy centers in the United States. This study recommends that guidelines for formal handoff procedures be developed and introduced as a quality metric for all NAEC-accredited epilepsy centers.

Psychiatric Mental Health Nurses' Perceptions and Experiences of Inpatient Mental Health Care Safety Culture in Saudi Arabia.

Although patient safety culture is gaining attention globally, more studies are needed to investigate its relevance to the nursing care of mental health (MH) patients. This study aimed to illustrate the perceptions and experiences of nurses who work in inpatient mental health care (IMHC) concerning the patient safety practices that are employed to avert safety hazards encountered during the provision of care in IMHC settings. Eighteen postgraduate students working as MH nurses in nonprofit hospitals comprised the study sample. The participants had a minimum of 2 years' nursing experience in IMHC settings. Each participant was interviewed individually using a guided interview technique. The inductive data underwent thematic analysis. Patient protection and a safety perspective were the overarching themes that emerged from the data. Three principal themes and 9 subthemes were illuminated: (a) patient care safety knowledge and background, (b) improving MH care, and (c) development of MH nursing care. The findings of this investigation may assist in providing guidance for the further research into and development of a patient safety culture appropriate for IMHC nursing practice, including increased structured educational experiences, judicious risk assessment, assignment of staff to include a mixture of skills and experience levels during assignments, use of standardized handoff procedures, engagement with multidisciplinary care providers, blame-free reflective information sharing and mentoring, and attention to the built environment with consideration of patient and staff safety needs.

Linguistic dissection of nursing handoffs: Implications for patient safety in varied-acuity hospital settings.

This study examines the intricate language and communication patterns of nurse-to-nurse handoffs across three units with varying patient acuity levels and nurse-patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. A mixed-methods cross-sectional design. This study used the Nurse-to-Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied-acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. This study underscores the critical role of language in nurse-to-nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high-acuity hospital settings. Nurses only.

Analysis ofMilitary-Civilian Patient Handoff at Vista Forge Multi-Agency Nuclear Disaster Exercise 2022.

The leadership of Vista Forge 2022 requested evaluation of the handoff process between military assets and civilian emergency medical services (EMS) providers by the Beth Israel Deaconess Fellowship in Disaster Medicine (BIDMF). Vista Forge was a multi-agency military-civilian full-scale disaster exercise coordinated by the U.S. Military. The exercise, held in Atlanta, Georgia, simulated response to a nuclear bomb in an urban setting by military and civilian disaster teams. BIDMF had several two-person teams who monitored handoff procedures between military assets after decontamination and civilian emergency medical services providers during the exercise evaluation. A verbal handoff between military and civilian entities was usually not done. Triage tags placed on mannequins before decontamination remained attached to the bodies and were sent with them to civilian hospitals. Triage tags were generic military forms without specific radiation or chemical exposure information. Not all decontamination groups had the same medical capabilities, and in a disaster it is unclear how these teams would manage medical emergencies. Future studies should develop a standardized handoff procedure to be used in mass casualty situations, and trial it in future multi-agency disaster exercises. Radiation specific triage tags should be considered.

Snake Optimization Technique for Spectrum Handoff in Cluster based Cognitive Radio Network

In Cognitive Radio (CR) networks, the use of Secondary Users (SU) in the spectrum has an undesirable effect on spectrum handoff, which causes a handoff delay. The handoff procedure can result in service outages and considerable transmission quality delays, making it a regular source of concern for the SU. An effective spectrum handoff strategy that utilizes the Spectrum Binary Snake Optimization (SBSO) algorithm and the M/G/1 queuing model has been proposed in this study. The use of Cluster Based Cooperative Spectrum Sensing improves SU performance and reduces channel congestion. In order to report the active and inactive channels in the spectrum, the cluster head is connected to the SU base station, and a decision report is subsequently generated by the fusion center. With the use of a bitwise and mutation operator format, SBSO reduces the overall service time required for handoff in the approach that is being proposed. The proposed methodology also provides a framework for observing how primary user activity and spectrum handoff delays behave in the presence of potential interruptions in a CR network. The simulation model of the proposed work optimizes the packet delivery ratio with the three benchmark functions, and provides optimal handoff, and is compared to SBSO and other models that offer a better trade off over delay achievement.

An Improved Handoff Algorithm for Seamless Connectivity in Heterogeneous Networks

Twenty-first century is an era of cutting-edge technologies. From artificial intelligence to nanotechnology, modern life has gathered the pace to match up with the shrinking time and fast-moving world. Likewise, a Heterogeneous Network finds its own space in this century of inventions. Every individual, industry, and institute needs to be connected to the internet cloud. Mobile applications have changed the dynamics of every individual’s life. From personal management to professional proficiency, mobile applications play an important role in almost every aspect. Numerous applications available these days demand continuous bandwidth connection. To remain always connected, there is a need for an effective handoff procedure. In this paper, we have proposed a convex optimization technique for optimizing the call drop probability, remaining energy and handoffs in heterogeneous networks. The proposed algorithm outperformed the already existing M-OPTG and M-WO algorithms.

Handoffs and Teamwork: A Framework for Care Transition Communication.

Handoffs occur frequently in the medical domain and are associated with up to 80% of medical errors. Although research has progressed, handoffs largely remain inadequate. The absence of an appropriate conceptual model for handoffs hinders the purposeful design and evaluation of handoff procedures. This article presents a theoretical model of the major input, team process, and output variables that should be considered during a handoff. The model integrates three theoretical frameworks that capture the various inputs, processes, and outputs surrounding handoff events through the lens of teamwork. Specifically, the model describes the environment, organization, people, and tools as inputs. Communication, leadership, coordination, and decision making serve as the processes, and the outputs are the organization, teams, providers, and patients.

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.

Utilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology

Abstract Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented. Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure. Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift. Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services.

Student Perceptions and Learning Outcomes of a Dissection Handoff Procedure in the Gross Anatomy Laboratory

BackgroundDissection of the human body takes considerable time and effort, but also provides opportunities for the introduction of clinical skills. One skill is the safe transfer (handoff) of a patient between healthcare teams, a process dependent on the accurate exchange of information. In order to provide medical students with opportunities to practice skills in teamwork and communication while also reducing time spent in the dissection process, a handoff procedure was piloted for use in the gross anatomy laboratory. This study reports initial findings on student perceptions of time usage, wellness, teamwork &amp; communication skills, and relevance to patient handoff, as well as impact on learning and performance through analysis of assessment data.MethodsFirst‐year medical students (n=296) at Wayne State University were briefed on how to complete handoffs and their fundamental role in care of future patients. Each anatomy group was divided into two groups, which alternated between roles as the “dissecting‐team” and “receiving‐team.” A handoff tool was developed and included written and verbal components. The written component included a standardized checklist, designed as a lab chart to ensure dissection as well as mimic a handoff document. During the verbal component, the dissecting‐team demonstrated structures to the receiving‐team and shared anticipated problems. The handoff trial took place during 10‐dissection labs covering the head and neck region. Students were asked to complete a presurvey prior to starting and a postsurvey after completing the handoff curriculum. Responses to the pre‐ and post‐ surveys were 59% and 61% of the class, respectively.ResultsOn the presurvey, 71.6% of students agreed/strongly agreed that dissection was too time consuming compared to 64.8% on the postsurvey. 82.9% agreed/strongly agreed in the postsurvey that handoffs provided students with more time to study. On the practical exam students performed better on questions covering content when they were on the dissecting‐team 69.4% correct compared to receiver‐team 65.1% (P&lt;0.0001). 61.3% said that handoffs positively affected their overall wellness in the postsurvey (up from 51.1% in the presurvey). 42.0% felt that the handoff process facilitated development of teamwork within their group while 58.0% felt neutral (28.2%) or disagreed (29.8%). 41.4% agreed participating in the handoff process helped them develop handoff skills necessary for patient handoffs while 58.6% were neutral (29.8%) or disagreed (28.7%).ConclusionStudents scored significantly lower on exam questions regarding structures they did not dissect, but perceived they had more time to study and felt a positive effect on wellness. Improvements in the handoff procedure are needed to more directly address teamwork and communication skills pertinent to success with future patient handoffs.

A Trust Framework to Detect Malicious Nodes in Cognitive Radio Networks

Cognitive radio is considered as a pioneering technique in the domain of wireless communication as it enables and permits the Cognitive Users (CU) to exploit the unused channels of the Primary Users (PU) for communication and networking. The CU nodes access the vacant bands/channels through the Cognitive Radio Network (CRN) cycle by executing its different phases, which are comprised of sensing, decision making, sharing (accessing) and hand-off (mobility). Among these phases, hand-off is the most critical phase as the CU needs to switch its current data transmissions to another available channel by recalling all the previous functions upon the emergence of a PU. Further, from the security perspective, a Malicious User (MU) may imitate the PU signal with the intention to never allow the CU to use its idle band, which ultimately degrades the overall network performance. Attacks such as the Cognitive User Emulation Attack (CUEA) and Primary User Emulation Attack (PUEA) may be encountered by the handoff procedure, which need to be resolved. To address this issue, a secure and trusted routing and handoff mechanism is proposed specifically for the CRN environment, where malicious devices are identified at the lower layers, thus prohibiting them from being part of the communication network. Further, at the network layer, users need to secure their data that are transmitted through various intermediate nodes. To ensure a secure handoff and routing mechanism, a Trust Analyser (TA) is introduced between the CU nodes and network layer. The TA maintains the record of all the communicating nodes at the network layer while also computing the rating and trust value of the Handoff Cognitive User (HCUs) using the Social Impact Theory Optimizer (SITO). The simulation results suggest that the proposed solution leads to 88% efficiency in terms of better throughput of CRN during data communication, the packet loss ratio, the packet delivery ratio and the maximum and average authentication delay and clearly outperforms the prevailing mechanisms in all the parameters.

Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations.

Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations.

Analysis of Spectrum Handoff delay using Finite Queuing model in Cognitive Radio Networks

Spectrum handoff is an inevitable phenomenon to exploit dynamic spectrum access in cognitive radio networks (CRNs) for better spectrum utilisation. When a licensed or primary user reclaims its operating channel, the cognitive user has to initiate a suitable handoff procedure for successful completion of its ongoing transmission. This paper analyses the prioritised proactive spectrum handoff decision for a finite capacity cognitive radio network using preemptive resume priority (PRP) M/G/1/K queuing model. Cumulative handoff delay (CHD) and total service time (TST) are taken to investigate the performance of the handoff strategies. We establish an analytical model of cumulative handoff delay and total service time of proactive switching spectrum handoff for the proposed finite length queuing network. The impact of queue length on performance measuring metrics such as CHD and TST in terms of arrival rate of primary users and mobility factor of spectrum holes are presented extensively.

Optimal Broadcast Strategy-Based Producer Mobility Support Scheme for Named Data Networking

&lt;p&gt;Named Data Networking is a consumer-driven network that supports content consumer mobility due to the nature of in-network catching. The catching suppressed unnecessary Interest packets losses by providing an immediate copy of the data and consumer-driven nature influencedthe mobile consumer to resend unsatisfied Interest packet immediately after the handoff. Once the producer moves to a new location, the name prefix changed automatically after handoff to the new router or point of attachment. The entire network lacks the knowledge of producer movement unless if the producer announces its new prefix to update the FIBs of intermediate routers. Lack of producer’s movement knowledge causes an increase of handoff latency, signaling overhead cost, Interests packets losses, poor utilization of bandwidth and packets delivery. Therefore, there is needs to provide substantial producer mobility support to minimize the handoff latency, handoff signaling overhead cost, reduce the unnecessary Interest packets loss to improve data packets delivery once a content producer relocated. In this paper, broadcasting strategy is introduced to facilitate the handoff procedures and update the intermediate routers about the producer movement. Hence, analytical investigation result of this paper addresses the deficiency of Kite scheme by minimizing handoff signaling cost and provides data path optimization after the handoff.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Secure handoff technique with reduced authentication delay in wireless mesh network

The aim of manuscript is to propose a secure handoff procedure by generating the tickets for the mesh clients which are divided into different zones of mesh routers according to their communication range. An authentication server looks over the entire network after a specific interval of time and is responsible for generating and updating the corresponding tickets of clients according to their zonal routers range. Whenever a mesh client enters into the range of another domain, to access the services from foreign mesh routers, roaming client has to prove its authenticity to the corresponding zonal router. Each mesh router stores the ticket of its zonal mesh client issued from authentication server and validates the roaming client by matching the ticket. The proposed mechanism reduces the issue of storage overhead and security threats at mesh client as all the tickets are stored in authentication server database and are issued upon the request. The proposed technique is validated over authentication delay and different probabilistic scenarios of authentication and is proved legitimate by discussing an empirical study against reported literature.

Probabilistic Verification Scenarios with Reduced Authentication Delay for Handoff Clients in Mesh Networks

In this paper, we have proposed a secure handoff procedure by generating and assessing the tickets for each mesh client which are divided among various zones of mesh routers depending on their transmission range. Further, a trusted third party authentication server is proposed that is responsible for generating and assigning the tickets of each mesh client which are stored distributively at mesh routers. However, during the mobility whenever the range of current serving mesh router decreases, the mesh client needs to connect to a foreign mesh router by authenticating itself in order to continue its network services. The foreign mesh router validates the authenticity of its handoff mesh client by verifying its ticket. The proposed mechanism reduces the potential issue of storage overhead and security threats at mesh clients as all the tickets are stored distributively in the database of each mesh router. The proposed technique is validated with a commercial simulator NS2 over certain network parameters and different probabilistic scenarios of authentication.

A Pilot Project Using Eye-Tracking Technology to Design a Standardised Anaesthesia Workspace.

Maximising safe handoff procedures ensures patient safety. Anaesthesiology practices have primarily focused on developing better communication tools. However, these tools tend to ignore the physical layout of the anaesthesia workspace itself. Standardising the anaesthesia workspace has the potential to improve patient safety. The design process should incorporate end user feedback and objective data. This pilot project aims to design a standardised anaesthesia workspace using eye-tracking technology at a single university-affiliated Veterans Affairs hospital. Twelve practising anaesthesiologists observed a series of images representing five clinical scenarios. Each of these had a question prompting them to look for certain items commonly found in the anaesthesia workspace. Using eye-tracking technology, the gaze data of participants were recorded. These data were used to generate heat maps of the specific areas of interest in the workspace that received the most fixation counts. The laryngoscope and propofol had the highest percentages of gaze fixations on the left-hand side of the workstation, in closest proximity to the anaesthesiologist. Atropine, although the highest percentage of gaze fixations (33%) placed it on the right-hand side of the workstation, also had 25% of gaze fixations centred over the anaesthesia cart. Gaze fixation analyses showed that anaesthesiologists identified locations for the laryngoscope and propofol within easy reach and emergency medications further away. Because eye tracking can provide objective data to influence the design process, it may be useful when developing standardised anaesthesia workspace templates for individual practices.

Teletraffic Analysis for VoIP Services in WLAN Systems with Handoff Capabilities

In this work, a TDMA-based system is studied for VoIP services with and without mobility. The system is considered to be dedicated for voice-only services such as a WLAN environment under the PCF mode or a cellular system. In such environments, mobiles usually have mobility. This introduces the need to study the system when a handoff procedure is enabled. The teletraffic analysis considers call arrivals, call completions, and ON/OFF activity processes for individual VoIP sessions. The VoIP system is simulated in order to verify the accuracy of the analytical results. Since many papers published in the literature consider a fixed number of VoIP users in the system, this analysis can be useful to estimate the system's performance when the system is in statistical equilibrium. As an additional feature of this work, a simple fluid model to calculate the number of active and inactive users in a VoIP system with and without handoff capabilities is proposed and developed.

Investigating Intraoperative and Intraprofessional Handoffs in Anesthesia

Handoffs occur frequently in healthcare systems, and miscommunications and critical omissions within handoffs have been linked to serious medical errors. Handoff quality is a priority of patient safety initiatives across several international organizations. The majority of previous research in handoffs have focused on postoperative handoffs; yet, there is a need to specifically investigate intraoperative handoffs, especially within individual professions or subspecialties. Each subspecialty within a surgical team may approach handoffs differently. The anesthesia team is especially unique as they take a team-based approach to patient care where multiple anesthesia providers may be involved in one surgical case. We describe an observational study of intraoperative and intraprofessional handoffs in anesthesia. Temporary and permanent handoffs were investigated as well as the contextual elements that influenced handoff procedures. In a sample of 35 video recorded surgeries, a total of 16 handoffs were identified for the maintenance phase of surgery. These handoffs ranged between 33 seconds and 7.42 minutes in duration. Our study revealed variability in intraoperative handoffs during the maintenance phase of anesthesia and emphasizes that intraoperative and intraprofessional handoffs warrant more in-depth examination in order to develop effective strategies or tools for high quality handoffs in anesthesia.