Handoff Communication Research Articles

Effect of Nursing Handoff Educational Bundle on Nurse Interns' Handoff knowledge and Communication Competence

Effect of Nursing Handoff Educational Bundle on Nurse Interns' Handoff knowledge and Communication Competence

Perceptions of Cognitive Load and Workload in Nurse Handoffs: A Comparative Study Across Differing Patient-Nurse Ratios and Acuity Levels.

Medical errors, often resulting from miscommunication and cognitive lapses during handoffs, account for numerous preventable deaths and patient harm annually. This research examined nurses' perceived workload and cognitive load during handoffs on hospital units with varying patient acuity levels and patient-nurse ratios. Conducted at a southeastern US medical facility, the study analyzed 20 handoff dyads using the National Aeronautics and Space Administration Task Load Index to measure perceived workload and cognitive load. Linear regressions revealed significant associations between patient acuity levels, patient-nurse ratios, and National Aeronautics and Space Administration Task Load Index subscales, specifically mental demand (P = .007) and performance (P = .008). Fisher exact test and Wilcoxon rank sum test showed no significant associations between these factors and nurses' roles (P > .05). The findings highlight the need for targeted interventions to manage workload and cognitive load, emphasizing standardized handoff protocols and technological aids. The study underscores the variability in perceived workload and cognitive load among nurses across different units. Medical-surgical units showed higher cognitive load, indicating the need for improved workload management strategies. Despite limitations, including the single-center design and small sample size, the study provides valuable insights for enhancing handoff communications and reducing medical errors.

Eliminating Hands-off Handoffs: Improvement in Perioperative Handoff Communication With a Multidisciplinary Tool Initiative

Eliminating Hands-off Handoffs: Improvement in Perioperative Handoff Communication With a Multidisciplinary Tool Initiative

Machine learning: implications and applications for ambulatory anesthesia.

This review explores the timely and relevant applications of machine learning in ambulatory anesthesia, focusing on its potential to optimize operational efficiency, personalize risk assessment, and enhance patient care. Machine learning models have demonstrated the ability to accurately forecast case durations, Post-Anesthesia Care Unit (PACU) lengths of stay, and risk of hospital transfers based on preoperative patient and procedural factors. These models can inform case scheduling, resource allocation, and preoperative evaluation. Additionally, machine learning can standardize assessments, predict outcomes, improve handoff communication, and enrich patient education. Machine learning has the potential to revolutionize ambulatory anesthesia practice by optimizing efficiency, personalizing care, and improving quality and safety. However, limitations such as algorithmic opacity, data biases, reproducibility issues, and adoption barriers must be addressed through transparent, participatory design principles and ongoing validation to ensure responsible innovation and incremental adoption.

Comparing the impact of PASS-BAR handoff education for new nurses between simulation-based and case-based approaches: A quasi-experimental design

AimTo develop a patient, assessment, situation, safety concerns, background, action, recommendation (PASS-BAR) handoff training program and compare the educational effects of the program between simulation-based (experimental group) and case-based (control group) groups using repeated measures among new nurses. BackgroundNew nurses are not well prepared to provide clear handoff reports because nursing schools and healthcare institutions rarely offer structured programs or training for handoff communication practices. DesignThis study used a pretest–posttest quasi-experimental design with repeated measures with two non-randomized groups. MethodsThis study targeted new nurses with less than 12 months of experience and was conducted at a university hospital’s clinical nursing education center in Seoul, South Korea, between September 2022 and April 2023. Seventeen participants were allocated to the experimental group and 17 participants to the control group. Both groups were given lectures and exercises for both scenarios. Participants were asked to complete a questionnaire on nursing handoff competency, handover performance competency and perceived self-efficacy of handoff at pre- and posttest and two weeks after training. Satisfaction with learning was measured after the intervention. ResultsWe developed a simulation-based learning handoff program that includes a simulated handoff performance and debriefing and a case-based learning handoff program that includes discussion, handoff performance and feedback. This study found no immediate difference in the educational effect of PASS-BAR handoff training between simulation-based learning and case-based learning; however, over time, simulation-based learning was more effective than case-based learning in improving nursing handoff competency and handover performance competency. ConclusionsBased on the results of this study, a simulation-based handoff training program using PASS-BAR can enhance handoff competencies and help new nurses strengthen their communication skills to understand patients and convey important information. Tweetable AbstractDeveloping a simulation-based handoff training program using PASS-BAR helps nurses strengthen their communication skills with colleagues.

Using structured communication to improve patient handoffs and reduce medical errors.

Communication errors during transfer of care from one clinician to another are a major cause of medical errors. In 2006, The Joint Commission made handoff communications a national patient safety goal. In 2014, the Association of American Medical Colleges included giving and receiving a report to transfer a patient's care as one of the 13 core entrustable professional activities required for entry into residency programs. Communication is the key to successful transfer of patient care from one clinician to another during shift change. A structured method of communication used by all clinicians in high-stakes healthcare settings can ensure all vital information about a patient is given to the receiving clinician.

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.

Centering health equity during handoff communications.

Centering health equity during handoff communications.

Don't interrupt me! development of a handoff education bundle to simulate the real world.

Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff. A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum. Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff. Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses. Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Eliminating Hands-Off Handoffs: Improvement in Perioperative Handoff Communication With a Multidisciplinary Tool Initiative.

Handoffs between the operating room (OR) and post-anesthesia care unit (PACU) require a high volume and quality of information to be transferred. This study aimed to improve perioperative communication with a handoff tool. Perioperative staff at a quaternary care center was surveyed regarding perception of handoff quality, and OR to PACU handoffs were observed for structured criteria. A 25-item tool was implemented, and handoffs were similarly observed. Staff was then again surveyed. A multidisciplinary team led this initiative as a collaboration. After implementation, nursing reported improved perception of time spent (2.63-3.68, p = .02) and amount of information discussed (2.85-3.73, p = .05). Anesthesia also reported improved personal communication (3.69-4.43, p = .004), effectiveness of handoffs (3.43-3.82, p = .02), and amount of information discussed (4.26-4.76, p = .05). After implementation, observed patient information discussed during handoffs increased for both surgical and anesthesia team members. The frequency of complete and near-complete handoffs increased (40%-74%, p < .001). A structured handoff tool increased the amount of essential information reported during handoffs between the OR and PACU and increased team members' perception of handoffs.

Urgent Communication and Interdepartmental Collaboration Across the Continuum of Care: An Ischemic Limb Patient Case

Through an urgent patient case of acute limb ischemia and intervention, care transitions are examined. The importance of safe, consistent transitions of care has become even more apparent after the COVID-19 pandemic when face-to-face communication was inhibited in many areas. The impact of urgent patient needs coupled with a high number of inexperienced staff enhances the need for appraisal of current handoff communication practices in all patient care areas. The reality is this; many of the most serious medical errors are linked to miscommunication. This ischemic limb patient case highlights inconsistencies in patient care transition processes and the associated risks that need to be addressed to improve patient care.

Improving handoff with the implementation of I-PASS at a tertiary oncology hospital

BackgroundLack of consistent and standardised handoffs is a leading cause of patient harm. With increased census in our hospital medicine (HM) service, failure to handoff using a standardised method has...

Standardized evaluation of hand-off documentation of ICU boarders in the emergency department.

The boarding of ICU patients in the emergency department (ED) represents a considerable risk to patient safety. This study aims to describe the generation of a rubric to ensure the fidelity of vital, written hand-off between ED teams. We performed a mixed methods design to develop a scoring rubric to evaluate written hand-off communication of medical ICU boarders between ED teams during the COVID-19 pandemic. The primary outcome was the quality of the written hand-off as agreed upon by the inter-user agreement. Our secondary outcome included variability in written quality as a function of the number of separate and distinct ED teams at the point of the transition of care. There was a moderate inter-user agreement with rubric scoring (κ=0.70 [95% confidence interval, 0.66-0.75]). The overall trend noted that several key elements, including code status, performed interventions, and contingency planning, were infrequently documented. We effectively created a quality assurance tool for ED ICU boarders that ensures relevant and vital information is relayed between ED teams. Our analysis demonstrated that all relevant information is only sometimes present in the hand-off.

Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity.

Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention. We conducted a prospective intervention study of children with medical complexity discharged at a children's hospital from April 2018 to March 2020. A multistakeholder team developed a bundled intervention incorporating the I-PASS handoff framework including a postdischarge telephone call, restructured discharge summary, and handoff communication to outpatient providers. The primary outcome measure was rate of postdischarge incidents collected via electronic medical record review and family surveys. Secondary outcomes were 30-day readmissions and ED visits. There were 199 total incidents and the most common were medication related (60%), equipment issues (15%), and delays in scheduling/provision of services (11%). The I-PASS intervention was associated with a 36.4% decrease in the rate of incidents per discharge (1.51 versus 0.95, P = 0.003). There were fewer nonharmful errors and quality issues after intervention (1.27 versus 0.85 per discharge, P = 0.02). The 30-day ED visit rate was significantly lower after intervention (12.6% versus 3.4%, per 100 discharges, P = 0.05). Thirty-day readmissions were 15.8% versus 10.2% postintervention (P = 0.32). A postdischarge communication intervention for patients with medical complexity was associated with fewer postdischarge incidents and reduced 30-day ED visits. Standardized postdischarge communication may play an important role in improving quality and safety in the transition from hospital-to-home for vulnerable populations.

Evaluating Physician Stress During Patient Handoffs: Analysis of Physician Heart Rate Variability, Patient Handoff Characteristics, and ED Metrics

Patient handoffs represent a critical point in patient care, specifically in hospital Emergency Departments (EDs) where handoffs occur at every shift change. Previous studies have examined ED patient handoffs primarily by evaluating handoff communication methods and scheduling models that improve and reduce the prevalence of handoffs. In this study, we provided a quantitative analysis of physician stress by measuring the HRV of outgoing and oncoming physicians during patient handoffs. We recorded descriptive data of each observed patient handoff using the status of patient disposition as a measure of physician workload, and retrospectively gathered patient outcome and ED metric data for multivariate analysis. Results demonstrate that attending physicians experience increased HRV during handoff periods over non-handoff periods, with a significant increase observed in outgoing physicians (α = 0.05). This study creates a framework for future work that considers health care worker stress and evaluates ED handoffs via the stress and workload transferred between emergency physicians.

Sustainability of an Operating Room to Pediatric Postanesthesia Care Unit Handoff Tool

The purpose of this quality improvement (QI) project was to reintroduce and assess the feasibility of a standardized, electronic health record (EHR) handoff tool and to evaluate the sustainability of a structured, team-based approach in a pediatric postanesthesia care unit (PACU). This QI project used an observational pre-post design using two separate convenience samples of handoffs and perianesthesia providers. A standardized EHR handoff tool was reintroduced for operating room to pediatric PACU handoff communication. Handoffs between anesthesia providers, surgery team members, and PACU nurses were observed pre- and postreintroduction of the EHR handoff tool. Anesthesia providers and PACU RNs received training for giving and receiving handoffs and were provided directions on locating the EHR handoff tool. A bedside audit of items communicated for the six handoff phases (introductions, situation, background, assessment, recommendations, and questions), handoff duration, team member participation, and handoff tool utilization were performed for 149 handoffs pre- and 146 handoffs postimplementation. To evaluate sustainability, the audits were compared to postimplementation data from the 2014 pilot handoff project. Following reintroduction, EHR handoff tool use increased from 4% to 19%. There was a statistically significant increase in items communicated for three of the six handoff phases when using the EHR tool (P < .05). There was no statistically significant increase in handoff duration (mean=3.66 minutes, SD=1.57 minutes) with the EHR handoff tool. Surgical team member presence for the team-based handoff increased from 90.7% pre to 95.9% post. Provider compliance with the team-based handoff approach, which includes a PACU RN, surgical team member, and anesthesia team member present for handoff, was sustained and increased 6 years postimplementation. Feedback from anesthesia providers and PACU RNs indicated mixed reports of satisfaction with the EHR tool, perceived handoff efficiency, and consistency in both giving and receiving handoff. Adherence to five of the six structured handoff phases, except introductions, was sustained and even improved 6 years following implementation. Evidence-based practice for handoff communication supports the use of a team approach and standardized EHR handoff tools. The reintroduction of a standardized EHR handoff tool improved the completeness of information transfer, yet did not lead to widespread adoption nor improved user satisfaction. There is an ongoing need to identify adoptable and sustainable perioperative handoff methods.

Improving Communication in the Medical Intensive Care Unit Through Standardization of Handoff Format: A Quality Improvement Project

ObjectiveTo decrease interruptions in handoff, increase compliance with a structured verbal handoff format, and increase compliance with handoff template completion in electronic medical records without increasing the length of handoff time. Patients and MethodsThe project timeline was from April 1, 2019, to February 1, 2020. Define phase data were obtained through a survey of stakeholders to identify the gap in needs. The baseline data included components from the illness severity, patient summary, action list, situational awareness and contingency plans, and synthesis by receiver (IPASS) handoff tool because this tool best aligned with information identified in the define phase. Observational data were collected in person and reviewed via audio recording for accuracy. Results were analyzed to determine adherence to the chosen intervention, the IPASS handoff tool, on which the stakeholders were educated and assessed prior to implementation. Five plan-do-study-act cycles were completed over 3 months to optimize the intervention. Final data were collected and analyzed using the same method as baseline data. ResultsAfter implementation of the IPASS handoff tool, there were more care plan components mentioned in the provider handoffs across all unique IPASS components, there were fewer observed distracting events, and there was increased compliance with electronic medical record handoff completion. The time of handover increased by 3 minutes. ConclusionA standardized handoff tool improved communication during provider handoffs by increasing the mention of pertinent details and reducing distracting events during handoff.

Patient handoffs and multi-specialty trainee perspectives across an institution: informing recommendations for health systems and an expanded conceptual framework for handoffs

BackgroundSafe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions.MethodsUsing a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees’ experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses.Results687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame.ConclusionsHealth systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment.

Implementing Best Practices for Decreasing Nurse Hesitancy to Call the Rapid Response Team: An Evidence-Based Quality Improvement Initiative.

Nurses, regardless of experience, sometimes wait for the Modified Early Warning Score to indicate physiological decline before initiating the hospital's Rapid Response Team (RRT). The goal of this quality improvement initiative was to reduce nurse hesitancy to call the RRT, as indicated by the monthly number of proactive calls before the Modified Early Warning Score increased and triggered an automated page. Education, planned handoff communication, debriefing, and good catch emails were the educational strategies used in the implementation of the quality improvement initiatives, encouraging RRT calls sooner. Increasing RRT knowledge and communication is an evidence-based practice strategy to reduce nurse reluctance to call the RRT. After implementation, monthly proactive RRT calls increased (χ2 [1, n = 1,964] = 14.6085, p = .000159). Bedside interventions, unscheduled transfers, and Acute Physiologic and Chronic Health Evaluation scores did not differ. Education, structured handoff communication, and acknowledging good catches reduced nurses' reluctance to call the RRT proactively. [J Contin Educ Nurs. 2023;54(6):281-288.].

Effective pharmacy provider handoff communication for transition of patient care in CF.

Pediatric PulmonologyEarly View CLINICAL CORRESPONDENCE Effective pharmacy provider handoff communication for transition of patient care in CF Cameron J. McKinzie PharmD, BCPPS, BCPS, CPP, Corresponding Author Cameron J. McKinzie PharmD, BCPPS, BCPS, CPP Cameron.mckinzie@unchealth.unc.edu orcid.org/0000-0003-1401-5628 Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA Correspondence Cameron J. McKinzie, PharmD, BCPPS, BCPS, CPP, Department of Pharmacy, University of North Carolina Medical Center, 101 Manning Dr, CB# 7600, Chapel Hill, NC 27599, USA. Email: Cameron.mckinzie@unchealth.unc.edu Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorCharissa Kam PharmD, BCPPS, CPP, Charissa Kam PharmD, BCPPS, CPP orcid.org/0000-0003-3419-2613 Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorJeffery T. Zobell PharmD, BCPPS, Jeffery T. Zobell PharmD, BCPPS orcid.org/0000-0001-6047-306X Pharmacy Department, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorDavid C. Young PharmD, David C. Young PharmD orcid.org/0000-0003-0977-7257 Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this author Cameron J. McKinzie PharmD, BCPPS, BCPS, CPP, Corresponding Author Cameron J. McKinzie PharmD, BCPPS, BCPS, CPP Cameron.mckinzie@unchealth.unc.edu orcid.org/0000-0003-1401-5628 Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA Correspondence Cameron J. McKinzie, PharmD, BCPPS, BCPS, CPP, Department of Pharmacy, University of North Carolina Medical Center, 101 Manning Dr, CB# 7600, Chapel Hill, NC 27599, USA. Email: Cameron.mckinzie@unchealth.unc.edu Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorCharissa Kam PharmD, BCPPS, CPP, Charissa Kam PharmD, BCPPS, CPP orcid.org/0000-0003-3419-2613 Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorJeffery T. Zobell PharmD, BCPPS, Jeffery T. Zobell PharmD, BCPPS orcid.org/0000-0001-6047-306X Pharmacy Department, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorDavid C. Young PharmD, David C. Young PharmD orcid.org/0000-0003-0977-7257 Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this author First published: 08 May 2023 https://doi.org/10.1002/ppul.26464Read the full textAboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation RecommendedBreakthrough therapies: Cystic fibrosis (CF) potentiators and correctorsGeorge M. Solomon MD, Susan G. Marshall MD, Bonnie W. Ramsey MD, Steven M. Rowe MD, MSPH, Pediatric PulmonologyPatient–Provider CommunicationRebecca J. W. Cline, The International Encyclopedia of Communication, [1]NO pathway in CF and non‐CF childrenJamie L. Wooldridge MD, Gail H. Deutsch MD, Marci K. Sontag MS, Iris Osberg, Daniel R. Chase BS, Philip E. Silkoff MD, Jeffery S. Wagener MD, Steven H. Abman MD, Frank J. Accurso MD, Pediatric PulmonologyQuantitative cytokine gene expression in CF airwayMarianne S. Muhlebach MD, William Reed PhD, Terry L. Noah MD, Pediatric PulmonologyCF: An X-ray database to assess effect of aerosolized tobramycinDubhfeasa M. Slattery MRCPI, David Zurakowski PhD, Andrew A. Colin MD, Robert H. Cleveland MD, Pediatric Pulmonology