Handoff Quality Research Articles

Interns Overestimate the Effectiveness of Their Hand-off Communication

Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication. Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns' rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews. We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern's believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high. Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver's understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality.

Improving Handoffs in the Emergency Department

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area.

Hospitalist handoffs: A systematic review and task force recommendations

Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety. To develop recommendations for hospitalist handoffs during shift change and service change. PubMed (through January 2007), Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network, white papers, and hand search of article bibliographies. Controlled studies evaluating interventions to improve in-hospital handoffs (n = 10). Studies were abstracted for design, setting, target, outcomes (including patient-level, staff-level, or system-level outcomes), and relevance to hospitalists. Although there were no studies of hospitalist handoffs, the existing literature from related disciplines and expert opinion support the use of a verbal handoff supplemented with written documentation in a structured format or technology solution. Technology solutions were associated with a reduction in preventable adverse events, improved satisfaction with handoff quality, and improved provider identification. Nursing studies demonstrate that supplementing verbal exchange with a written medium leads to improved retention of information. White papers characterized effective verbal exchange, as focusing on ill patients and actions required, with time for questions and minimal interruptions. In addition, content should be updated daily to ensure communication of the latest clinical information. Using this literature, recommendations for hospitalist handoffs are presented with corresponding levels of evidence. Recommendations were reviewed by hospitalists at the Society of Hospital Medicine (SHM) Annual Meeting and by an interdisciplinary team of expert consultants and were endorsed by the SHM governing board. The systematic review and resulting recommendations provide hospitalists a starting point from which to improve in-hospital handoffs.

Use of strategies from high-reliability organisations to the patient hand-off by resident physicians: practical implications

Background:Limits on resident hours increase the frequency of patient hand-offs and may contribute to information transfer problems that contribute to adverse outcomes. This study analysed attributes that affect hand-off accuracy,...

Patient Handoffs in Obstetrics and Gynecology: A Vital Link in Patient Safety

Inadequate patient handoffs have been an area of focus for patient safety improvement. Insufficient communication and risks or “shortcuts” taken by staff members during handoffs could negatively affect the safety of patients in a department of obstetrics and gynecology. Other factors that contribute to inadequate handoffs are the caregiver feeling fatigued or stressed, level of urgency, volume of information, language barriers, noise, lighting, ambiguity of describing treatment, not allotting enough time for questions asked, and/or interruptions from other staff members. There have been several methods developed for improving the handoff process, such as the mnemonic devices SBAR, SHARQ, I PASS THE BATON, and the 5 P's. A new method for improving the quality of patient handoffs has been developed and presented in this article. It is a mnemonic device entitled “HANDOFFS”. It covers key aspects of what a handoff process should entail. Teamwork is essential to effective communication, and by using a mnemonic such as this, team members can work together in a more positive and accessible environment that will result in improved patient safety.

Handoffs Causing Patient Harm: A Survey of Medical and Surgical House Staff

Communication lapses at the time of patient handoffs are believed to be common, and yet the frequency with which patients are harmed as a result of problematic handoffs is unknown. Resident physicians were surveyed about their handoffpractices and the frequency with which they perceive problems with handoffs lead to patient harm. A survey was conducted in 2006 of all resident physicians in internal medicine and general surgery at Massachusetts General Hospital (MGH) concerning the quality and effects of handoffs during their most recent inpatient rotations. Surveys were sent to 238 eligible residents; 161 responses were obtained (response rate, 67.6%). Fifty-nine percent of residents reported that one or more patients had been harmed during their most recent clinical rotation because of problematic handoffs, and 12% reported that this harm had been major. Overall quality of handoffs was reported to be fair or poor by 31% of residents. A minority of residents (26%) reported that handoffs usually or always took place in a quiet setting, and 37% reported that one or more interruptions during the receipt of handoffs occurred either most of the time or always. Although handoffs have long been recognized as potentially hazardous, further scrutiny of handoffs has followed recent reports that handoffs are often marked by missing, incomplete, or inaccurate information and are associated with adverse events. In this study, reports of harm to patients from problematic handoffs were common among residents in internal medicine and general surgery. Many best-practice recommendations for handoffs are not observed, although the extent to which improvement of these practices could reduce patient harm is not known. MGH has recently launched a handoff-safety educational program, along with other interventions designed to improve the safety and effectiveness of handoffs, for its house staff and clinical leadership.

MACD-Based Motion Detection Approach in Heterogeneous Networks

Optimizing the balance between handoff quality and power consumption is a great challenge for seamless mobile communications in wireless networks. Traditional proactive schemes continuously monitor available access networks and exercise handoff. Although such schemes achieve good handoff quality, they consume much power because all interfaces must remain on all the time. To save power, the reactive schemes use fixed RSS thresholds to determine when to search for a new available access network. However, since they do not consider user motion, these approaches require that all interfaces be turned on even when a user is stationary, and they tend initiate excessive unnecessary handoffs. To address this problem, this research presents a novel motion-aware scheme called network discovery with motion detection (NDMD) to improve handoff quality and minimize power consumption. The NDMD first applies a moving average convergence divergence (MACD) scheme to analyze received signal strength (RSS) samples of the current active interface. These results are then used to estimate user's motion. The proposed NDMD scheme adds very little computing overhead to a mobile terminal (MT) and can be easily incorporated into existing schemes. The simulation results in this study showed that NDMD can quickly track user motion state without a positioning system and perform network discovery rapidly enough to achieve a much lower handoff-dropping rate with less power consumption.

Simulation Training for Rapid Assessment and Improved Teamwork-Lessons Learned from a Project Evaluating Clinical Handoffs

Effective communication between clinicians is a crucial component of safe care. High-quality communication may be especially critical during care transitions between clinicians (handoffs). In a two-year quasi-experimental Quality Improvement project, we are using simulation learning to evaluate and improve communication between anesthesia providers and nurses as care is transitioned from the operating room to the post-anesthesia care unit (PACU). Using a multiple baseline, staggered entry, prospective cohort design with repeated measures, we are introducing a training intervention and evaluating its effects on dyadic communication. The primary hypothesis is that simulation-based communication skills training of PACU personnel will significantly improve the quality of handoffs. Clinicians' performance is being compared before and after their training on four dimensions of handoff effectiveness: information transfer; use of best evidence handoff strategies; interpersonal skills; and team behaviors. Clinicians also rate their own handoffs. Lessons learned and results to date will be presented.

Micro mobility in the IP networks

Wireless access to Internet services will become typical, rather than the exception as it is today. Such a vision presents great demands on mobile networks. Mobile IP represents a simple and scalable global mobility solution but lacks the support for fast handoff control and paging found in cellular telephony networks. In contrast, second- and third-generation cellular systems offer seamless mobility support but are built on complex and costly connection-oriented networking infrastructure that lacks the inherent flexibility, robustness, and scalability found in IP networks. This paper presents an overview and performance comparison of two of the main micro-mobility protocols, namely Cellular IP and Hierarchical Mobile IP with regards to the handoff process for UDP applications. The differences in the handoff quality of the two protocols are small and can be traced to design choices within the typical model. There are however significant differences regarding the processing requirement, routing efficiency and parameters relating to implementation and deployment.

Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs

Handoffs involve the transfer of rights, duties, and obligations from one person or team to another. In many high-precision, high-risk contexts such as a relay race or handling air traffic, handoff skills are practiced repetitively to optimize precision and anticipate errors. In medicine, wide variation exists in handoffs of hospitalized patients from one physician or team to another. Effective information transfer requires a solid foundation in communication skills. While these skills have received much attention in the medical literature, scholarship has focused on physician-to-patient, not physician-to-physician, communication. Little formal attention or education is available to reinforce this vital link in the continuity of patient care. The authors reviewed the literature on patient handoffs and evaluated the patient handoff process at Indiana University School of Medicine's internal medicine residency. House officers there rotate through four hospitals with three different computer systems. Two of the hospitals employ a computer-assisted patient handoff system; the other two utilize the standard pen-to-paper method. Considerable variation was observed in the quality and content of handoffs across these settings. Four major barriers to effective handoffs were identified: (1) the physical setting, (2) the social setting, (3) language barriers, and 4) communication barriers. The authors conclude that irrespective of local context, precise, unambiguous, face-to-face communication is the best way to ensure effective handoffs of hospitalized patients. They also maintain that the handoff process must be standardized and that students and residents must be taught the most effective, safe, satisfying, and efficient ways to perform handoffs.

Signal-based evaluation of handoff algorithms

We propose a new framework, based on signal quality, for performance evaluation and comparison between existing handoff algorithms. It includes new call quality measures and an off-line cluster-based computationally-simple heuristic algorithm to find a near optimal handoff sequence used as a benchmark. We then compare existing handoff algorithms and identify the trade-off between signal quality and number of handoffs.

QoS maintenance for fair queueing algorithms in wireless mobile networks

AbstractIn order to extend fair queueing algorithms to wireless networks, we propose a channel error and handoff compensation scheme. A compensation is performed by a compensation server and a priority swapping mechanism. The proposed compensation scheme provides a short‐term fairness guarantee for an error‐free session, long‐term fairness guarantee for an erroneous session, fast handoff and traffic‐specific quality of service control. Copyright 2002 John Wiley & Sons, Ltd.

Adaptive hard handoff algorithms

The design of hard handoff algorithms based on optimizing the tradeoff between link quality and rate of handoffs is considered. For handoff algorithms based on this criterion, adaptation is precisely defined in terms of remaining on a locus of desirable operating points as system parameters (such as mobile velocity) change. A rule based on a linear cost criterion is used to select desirable operating points. For this rule, it is shown that the optimal handoff algorithm, which is impractical, is easily adapted by fixing a single tradeoff parameter at an appropriate value. The same adaptation property is shown to hold for an easily implementable approximation to the optimal algorithm, the locally optimal (LO) handoff algorithm. This is in contrast to the poor adaptation of hysteresis based approaches which require lookup tables for adaptation. Practical estimators for all relevant system parameters based on a short window of pilot signal strength measurements are also discussed. It is shown that the LO algorithm adapts well when these simple estimators are used. A hysteresis-threshold approximation to the adaptive LO algorithm is also developed.