Handoff Experience Research Articles

Nursing handoff education: An integrative literature review.

This integrative review aimed to identify nursing students' experiences of handoff practices and the effects of handoff education in the curriculum on nursing student learning outcomes. Appropriate handoff communication skills are essential for nursing students to maintain patient safety and prevent adverse events. A systematic literature search was conducted with keywords related to nursing, student, and handoff in April 2020. Articles should focus on nursing students' handoff education published in English in 2015-2020. Eight articles met the inclusion criteria and were included in this review. Nursing students reported discrepancies in handoff experiences; diverse factors influenced their handoff experiences, such as knowledge, anxiety, confidence, and type of student supervision. Various handoff educations were implemented across studies. Some handoff educations significantly improved nursing students' attitudes toward other disciplinary providers, satisfaction, confidence, quality, and clarity in handoff communication; some did not substantially affect their selected outcomes. This review identified that there are still limited handoff experiences among nursing students and many factors affecting opportunities for their handoff experience. Some handoff education (e.g., structured handoff formats, role-play, simulated scenarios) effectively improved students' communication clarity, confidence levels, and handoff education satisfaction. More handoff education is needed for nursing students to learn safe and quality handoff practices.

Evaluating the Implementation of a Medical Student’s Handoff Curriculum During the Surgery Clerkship

IntroductionEarly introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical clerkship. MethodsA multi-center prospective cohort study was performed at two medical schools. Training in the intervention group (HC) consisted of a didactic lecture, video review, and practice session. Students completed a pre-clerkship knowledge test and confidence/anxiety/handoff experience questionnaire pre- and post-clerkship. ResultsThere were no significant differences in pre-clerkship handoff experiences between institutions except having previously witnessed a verbal handoff (School A 96.4% versus School B 76.2%, P = 0.01). While there were no significant differences in post-clerkship confidence or anxiety, HC students were significantly more involved with written sign-outs (52.9% versus 18.2%, P = 0.02) and verbal handoffs (29.4% versus 4.6%, P = 0.03). ConclusionsMedical students exposed to handoff training shared similar confidence and anxiety scores compared to those that were not, however, they were more involved in handoff experiences during their surgical clerkship. Early introduction to handoff skills may encourage greater participation during subsequent clinical experiences.

Implementing Standardization into Patient Handoffs in Radiation Oncology Residency

<h3>Purpose/Objective(s)</h3> Patient handoff is vital for quality care and smooth transition of patient information between practitioners. Poorly executed handoffs can result in critical and potentially life-threatening patient care errors. Well-designed patient handoff workflows have demonstrated reduced patient errors and reduced stress for patient care teams. The radiation oncology patient workflow includes a complex diagram of multiple handoffs from the initial consult to the completion of treatment. Resident physicians play a key role in updating patient status designations and as such, because of clinical rotation transitions as part of the learning experience, a critical handoff with a high volume of patient information occurs every three months. This quality improvement project focused on the use of a standardized patient handoff format in our department. We hypothesized that the creation of a standardized process would improve the overall patient handoff experience for resident physicians. <h3>Materials/Methods</h3> Using a dedicated Radiation Oncology EMR we developed a standardized patient handoff process that included key timeline designations (KTD) from the initial consult to completion of treatment. Each patient had a designated area where the KTD was updated by the resident physicians. KTD included: pending decision, pending results, pending neoadjuvant care, pending surgery, pending sim, pending contours, pending plan, pending treatment scheduling, on treatment, pending follow up. Resident physicians utilized the EMR with KTD indicators as the source for patient handoffs during clinical rotation transitions. Following the transition, a brief survey was sent to the residents to assess the need for patient handoff, the effectiveness of the new handoff system, and general ideas on what works with the new handoff system, as well as suggested areas of improvement. <h3>Results</h3> A total of 6 surveys was sent out with a 100% response rate. Survey results revealed, 83% of residents felt handoffs were important for consults, 83% felt they were important for simulated patients, and 66% placed importance on handoff for "on-treatment" patients. The majority, 83%, preferred a centralized hand off area. Regarding the old handoff system, 33% were satisfied, 33% were neutral, and 33% were dissatisfied. With the new system, residents reported 40% satisfaction and 60% neutral. <h3>Conclusion</h3> The results of this project showed an improvement in the handoff system in comparison to the previous system while raising resident physician satisfaction during service transitions. Residents agreed patient handoffs at many different points of treatment planning are important, and the utilization of a centralized location for patient handoffs resulted in improved satisfaction. Future studies will evaluate the utilization of this centralized process's ability to reduce patient errors.

Impact of a Standardized Patient Hand-off Tool on Communication between Emergency Medical Services Personnel and Emergency Department Staff

Introduction Handoff communication between Emergency Medical Services (EMS) and Emergency Department (ED) staff is critical to ensure quality patient care. In January 2016, the Southwest Texas Regional Advisory Council (STRAC) implemented MIST (Mechanism, Injuries, vital Signs, Treatments), a standardized EMS to ED handoff tool. The En route Care Research Center conducted a Pre-MIST implementation survey of ED staff in December 2015 and a Post-MIST follow-up survey in July 2017 to determine the impact of the MIST handoff tool on the perceived quality of transmission of pertinent patient information and in the overall handoff experience. Methods We administered a nine-item Likert scale questionnaire to Brooke Army Military Medical Center (BAMC) ED providers and nurses before and after implementation of MIST. The questionnaire captured perceived competence and satisfaction with handoff communication (Cronbach’s alpha 0.73). We analyzed responses for the total sample and by occupation (providers and nurses), and we calculated odds ratios to determine items that may be most predictive of a positive handoff experience from the perspective of the ED staff. We performed chi-square tests and reported data as percentages. Results Total respondents Pre- and Post-MIST were 128 (62%) nurses and 80 (38%) providers (MDs, DOs, and PAs). Following the implementation of MIST, more respondents reported that they were "informed of prehospital treatments" (p < 0.001), that "Red/Blue Trauma Alert Criteria were conveyed” (p < 0.001), and that the "time to give the report was sufficient to convey pertinent information” (p < 0.001). Nurses more frequently reported that "Red/Blue Trauma Alert Criteria were conveyed" post-MIST (p < 0.01). Providers more frequently reported that "Assessment findings were conveyed" (p < 0.05), that they ‘interrupted the report for clarification" (p < 0.04), that "time to give the report was sufficient to convey pertinent information" (p < 0.001) and that they "felt positive about the overall handoff experience" (p < 0.03) Post-MIST. Overall satisfaction with the handoff was associated with frequently being informed of prehospital treatments (OR 5.5; 2.1–14.4) and frequently receiving a copy of the prehospital record (OR 2.9; 1.1–7.2). Conclusions These data demonstrate that providers and nurses reported an improvement in the handoff experience Post-MIST. This study supports the use of a standardized handoff tool at this critical step in patient care.

Standardization improves postoperative patient handoff experience for junior clinicians.

Effective communication among health care providers is critically important for patient safety. Handoff of patient care from the operating room (OR) to the intensive care unit (ICU) is particularly prone to errors. The process is more complicated in an academic environment in which junior clinicians are being trained. Standardization of, and training in, transitions of care can be a crucial means to improve patient safety. Pre- and postintervention surveys of health care providers. Based on a workflow analysis and qualitative needs assessments, we developed a 3-step protocol to standardize the handoff of care from the OR to the ICU for adult patients after cardiac surgery and to provide an effective learning environment. The process starts during surgery, continues when the patient leaves the OR, and concludes with the actual face-to-face transfer of care between providers, at the bedside, in the ICU. We conducted pre- and postimplementation surveys among physician trainees and nursing staff regarding their perception of the handoff process. We surveyed 42 clinicians before and 33 after implementation of the handoff process. Prior to implementation, most clinicians expressed a need to improve the current process; this perceived need was significantly greater in health care professionals with 4 or fewer years of experience. Post implementation, clinicians saw a significant improvement in information provided, efficiency, relevance to patient care, and psychological safety, a concept in which participants feel accepted and respected in a group setting without fear of negative consequences or judgement. Our workflow-oriented, standardized process for handoff of care from the OR to the ICU can improve perceived communication and psychological safety, especially for junior clinicians.

Designing a Process for Cardiology Patient Transfers: A Quality Improvement, Descriptive Study on Interprovider Communication and Resident Education.

Background:Patient transitions create vulnerability for care teams. Failures in the handoff process result in communication errors and knowledge gaps, mainly when the handoff occurs between resident and expert-level subspecialty clinicians. The authors set out to develop a standardized handoff using resident comfort as a proxy for implementation. The primary measurable aim of this study was to increase the percentage of pediatric residents who self-reported comfort in assuming care of patients transitioned from the cardiac intensive care unit to the cardiology acute care unit.Methods:Investigators surveyed residents at a 323-bed pediatric hospital on their handoff experiences. The study team performed a Failure Mode Effect Analysis and created a key driver diagram. Interventions included a transfer checklist and algorithm, a huddle between care teams, and education surrounding the transfer process.Results:Residents completed a survey before (n = 74) or after (n = 23) intervention. The percentage of residents who reported feeling “always” or “very often” prepared to care for patients at the time of transfer increased from 15% to 83%. The percentage of residents who reported that they “always” or “very often” had concerns about floor appropriateness decreased from 23% to 4%.Conclusions:The authors designed a transfer process to improve communication, resident-level education, and psychological safety among team members to ensure safe, thorough handoffs between providers with different levels of training. Although we cannot definitively conclude that resident comfort improved due to a small “n” postintervention, we offer a description outlining process changes, barriers to implementation, and lessons learned.

Content counts, but context makes the difference in developing expertise: a qualitative study of how residents learn end of shift handoffs

BackgroundHandoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents’ perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs.MethodsA qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts.ResultsAlthough some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients.ConclusionsResidents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.

An inter-professional approach to train and evaluate communication accuracy and completeness during the delivery of nurse-physician student handoffs

Abstract Importance The I-PASS training bundle has been shown to improve communication errors during medical student and resident handoffs but has not been explored in the context of interprofessional care. Objective We examined the impact of an interprofessional I-PASS training on communication accuracy and completeness during the delivery of nurse-physician student handoffs. Design, participants, and setting A pre-post comparative design was used to evaluate the differential impact of training on sixty-three first year nursing students and sixty-nine first year medical students, as part of an interprofessional curricular intervention, at an integrated university campus. Intervention The interprofessional I-PASS training was adapted from the existing I-PASS: Medical Student Workshop by a team of interprofessional faculty and presented to nursing and medical students. Main measures Simulated patient handoffs were used to assess communication performance prior to and following training. Evaluation involved the transcription and scoring of all verbal units delivered during the nurse-physician student handoffs based on four levels of information accuracy: correct, missing, erred, and omitted. Proportional changes in verbal units produced during pre and post-training encounters were compared at the combine total and individual domain levels based on training, student type, gender, previous handoff experience, and their interactions. Results Significant improvements in the proportions of correct, erred, and omitted verbal units at the combined total levels were observed across students, all p Discussion I-PASS training can improve communication accuracy and completeness during nurse-physician student handoffs. An event-based tool and coding procedure allowed for the identification of differential training impact based on individual handoff domains and provider demographics.

Practicing handoffs early: Applying a clinical framework in the anatomy laboratory.

The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation, Background, Assessment, Recommendation" (SBAR) handoff framework within the anatomy laboratory. Study participants included 147 second-year medical students completing the head and neck portion of an anatomy course. The authors used mixed methods to evaluate the impact of the anatomic SBAR on the student anatomy laboratory experience. Qualitative analysis of student evaluations revealed three themes which emerged from students' summaries of their anatomic handoff experiences: Learning-by-teaching; Acquiescing to doing more with less; and Distrust of the peer handoff process. All the themes demonstrated that the anatomic handoff encouraged students' focus on the knowledge preparation and reflection. Closed question analysis suggested that that students' perceptions of handoff usefulness were tied to deeper learning strategies. The handoff provided a mechanism for promoting students' focus on anatomical relationships and facilitated students' learning of transferable clinical skills. Together, these results suggest that the introduction of a handoff process in anatomy education provided both a mechanism for learning anatomy and a unique opportunity for early exposure to an essential clinical skill. This clinical and basic science integration may serve as a vertical integration thread which can be woven throughout undergraduate medical education. Future study will focus on exploring the long-term impacts and learning outcomes of this integration. Anat Sci Educ 9: 476-487. © 2016 American Association of Anatomists.

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking. Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance. Graduate Medical Education (GME) orientation at an urban, academic medical center. Eighty-four incoming residents from four residency programs participated in the study. The curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally "handed off" three mock patients of varying acuity and were evaluated by a trained "receiver" using an expert-informed, five-item checklist. Prior handoff experience in medical school was associated with higher checklist scores (23% none vs. 33% either third OR fourth year vs. 58% third AND fourth year, p = 0.021). Prior training was associated with prioritization of patients based on acuity (12% no training vs. 38% prior training, p = 0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting. The M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.

Assessment of a Brief Handoff Skills Workshop for Incoming Interns: Do past Handoff Experiences Impact Training Outcomes?

BackgroundPatient care handoffs are a core professional activity that incoming interns are expected to perform without direct supervision upon starting residency, yet training in medical schools is inconsistent.ObjectiveTo implement a brief handoff communication workshop for incoming interns and determine whether learner-level determinants were associated with differences in training outcomes.MethodsWe conducted a one-hour interactive handoff skills workshop for all incoming interns at a Midwestern academic medical center. We performed paired pre/post-intervention assessments of participants' attitudes and ability to perform representative handoff skills. The results were analyzed in aggregate and based upon participants' prior handoff experiences using Wilcoxon signed-rank test.ResultsNinety-nine of 108 interns (91.7%) completed both pre- and post-surveys. There was significant improvement in all 10 attitude-based questions (P ≤ 0.014 for all) and on the skills assessment (1.07 vs 2.16 on 0–4 point scale, SD 1.25, P ≤ 0.001). Results remained significant regardless of prior training, number of handoffs observed, number of handoffs performed, medical school, or residency discipline.ConclusionA brief interactive workshop for incoming interns can improve participants' confidence and performance of basic handoff skills, regardless of previous training or experience.

Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education.

Handoffs are an integral component of patient care, and the number of handoffs has increased as a result of duty hours restrictions for resident physicians. A structured handoff curriculum improves accuracy and has been shown to decrease medical errors. A standardized approach across all specialties is lacking in the published literature. The authors discuss the development and implementation of an institution-wide handoff curriculum for incoming first-year residents. An Innovation in Graduate Medical Education committee, including faculty from multiple specialties, identified an educational deficiency in handoffs and selected this as the target for the educational innovation. Meetings were held to develop and implement an extensive handoff curriculum for incoming first-year residents. The designed curriculum included large- and small-group sessions, and a specialty-specific observed simulated handoff experience. The authors analyzed participants' pre- and postsurveys using descriptive statistics. One hundred and twenty-four participants attended the formalized handoff training day. Following training, residents recognized that dedicated time for verbal exchange, templates for accessing and recording information, interactive handoffs giving priority to ill patients, and highlighting action items were most important for effective handoff. Both undergraduate and graduate medical education curricula need to develop formalized training and methods to assess competencies in handoffs. Training incoming residents is a logical starting place, but programs should be systematically disseminated across all specialties, from residents to faculty, in order to be effectively integrated into the culture of an institution.

Internal Medicine Postgraduate Training and Assessment of Patient Handoff Skills

Effective communication during patient care transitions is essential for high-quality patient care. The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill. We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence. Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation = 0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean = 79%, SD = 4.6) and PGY-2 residents (mean = 82%; SD = 7.6; P = .07). The PGY-2 residents were significantly more experienced (P < .001) and confident (P < .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance. Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.

Closing the Gap: A Needs Assessment of Medical Students and Handoff Training

Closing the Gap: A Needs Assessment of Medical Students and Handoff Training

Optimization model for handoff-aware channel assignment problem for multi-radio wireless mesh networks

Optimal channel assignment (CA) in multi-radio wireless mesh networks is an NP-hard problem for which solutions usually leave several links interfering. Most of these solutions usually consider the overall throughput as the main optimization objective. However, other objectives have to be considered in order to provide better quality wireless connections to non stationary users. In this paper, we propose a multi-objective optimization model that, besides maximizing throughput, improves fairness and handoff experience of mesh clients. In this model, we use the Jain’s index to maximize users’ fairness and we allow same-channel assignments to links involved in the same high handoff traffic, thus reducing handoff-triggered re-routing characterized by its high latency. Then, we propose a centralized variable neighborhood search and a Tabu search heuristics to efficiently solve our model as an offline CA process. Moreover, in order to adapt to traffic dynamics caused especially by user handoffs, we propose an online CA scheme that carefully re-assigns channels to interfaces with the purpose of continuously minimizing the re-routing overhead/latency during user handoffs. We further improve this online scheme using load balancing. Simulation results show the good performance of our proposed approach in terms of delay, loss rate, overall throughput and fairness. Particularly, performance results of our online handoff-aware CA show the effectiveness of handoffs not involving path re-routing in decreasing the delay, especially when considering load balancing.

Enhancing Patient Safety

Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.

Efficient and scalable, end-to-end mobility support for reactive and proactive handoffs in IPv6

Handoff performance with mobile IPv6 strongly depends on the efficiency of IP-layer configuration mechanisms as well as the flexibility of mobile nodes to schedule and parallelize their signaling. This article provides a comprehensive analysis of the handoff performance with standard IPv6 protocols and mobile IPv6, and identifies several sources for delay. Some of the delays are already well known, but an optimized and widely applicable handoff approach is yet to be found. While substantial efforts are currently being invested into localized mobility-management architectures, such approaches feature poor scalability and limited deployability given their requirements in terms of financial investments and coordination across administrative borders. This article hence explores a number of promising IPv6 and end-to-end mobile IPv6 optimization proposals, some of which are currently under standardization within the IETF, and elaborates how a combination of those can significantly improve handoff experience without loss of scalability. The article further shows that the optimizations may not only improve reactive handoff performance, but also facilitate efficient proactive handoff management

SIP-based vertical handoff between WWANs and WLANs

Future-generation wireless networks have been envisioned as the integration of various wireless access networks, including both wireless wide area networks and wireless local area networks. In such a heterogeneous network environment, seamless mobility support is the basis of providing uninterrupted wireless services to mobile users roaming between various wireless access networks. Because of transparency to lower-layer characteristics, ease of deployment, and greater scalability, the application-layer-based session initiation protocol has been considered the right candidate for handling mobility in heterogeneous wireless networks. However, SIP entails application-layer transport and processing of messages, which may introduce considerable delay. As a case study of the performance of mobility management protocols in the heterogeneous wireless networks, we analyze the delay associated with vertical handoff using SIP in the WLAN-UMTS internetwork. Analytical results show that WLAN-to-UMTS handoff incurs unacceptable delay for supporting real-time multimedia services, and is mainly due to transmission of SIP signaling messages over erroneous and bandwidth-limited wireless links. On the other hand, UMTS-to-WLAN handoff experiences much less delay, mainly contributed by the processing delay of signaling messages at the WLAN gateways and servers. While the former case requires the deployment of soft handoff techniques to reduce the delay, faster servers and more efficient host configuration mechanisms can do the job in the latter case.