Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September

Strategies for Shift Handoff

Jan Rebstock, RHIT, LHRM, CPHRM
2-4-1   Shift handoff is a basic health care practice designed to provide continuity of patient care from one health care team to another. The omission or ineffective handover of essential transfer information can lead to delays in treatment, missed treatment, or the wrong treatment. Shift handoff may also result in longer response time to patient requests if the handoff is not conducted in a timely manner. As a result, implementing effective as well as efficient strategies to ensure that pertinent patient information is communicated, received, understood, and acted upon is critical.   The Joint Commission has identified lack of communication as the number one root cause of reported sentinel events. Dr. Richard Crouteau, M.D., JCAHO’s Executive Director of Strategic Initiatives, states that “Misinformation or ineffective communication at handoff points is one of the most common causes of adverse events and two-thirds of all of our sentinel events are related to breakdowns in communication, and most of that is at handoffs.” 1   Not surprisingly, one of JCAHO’s 2006 patient safety goals requires hospitals to implement a standardized approach to handoff communications, including an opportunity for staff to ask and respond to questions.   One of the key points identified by the Australian Council for Safety and Quality in Health Care in drafting recent national operational principles for a clinical handover program is that it be structured, efficient, effective and action oriented; existing within and between all levels of health care.2   In applying lessons learned from NASA’s Space Mission Control and others, some recognized points of vulnerability include:3  

• Being unaware of significant data or events;

• Being unprepared to deal with impacts from previous events;

• Failing to anticipate future events;

• Lacking knowledge to perform necessary tasks;

• Dropping or reworking activities that are in progress or that the team has agreed to; and

• Creating an unwarranted shift in goals, decisions, priorities, or plans.

  In developing standard protocols for shift handoff, the following are some strategies found to be effective by some hospitals and other industries:4  

• Face-to-face verbal updates between the responsible outgoing provider and incoming provider to allow for interactive questioning.

  “The greatest problem in communication is the illusion that it has been accomplished.” George Bernard Shaw  

• Chart throughout the day as care is rendered or events occur to allow more time for face-to-face patient status updates at change of shift.

• Electronic/written summaries of patient status, allowing for read-backs to facilitate clarification. Development of a standardized checklist of minimum patient data or items to discuss at each changeover.

• Allowing patient updates to be heard by more than one staff member to verify completeness/accuracy of information.

• Encouraging incoming as well as outgoing staff to initiate topics to avoid chances of missing important information.

• Limiting interruptions during shift updates.

• Completing critical activities before transfer of responsibility.

• Avoiding starting actions (whenever possible) until after the handoff is completed.

• Assuring that transfer of responsibility is unambiguous and that outgoing staff maintains responsibility until handoff of duties is complete, staying through any crisis that may emerge during the handoff.

• Utilizing technology that may enhance the efficiency of information transfer, such as personal digital assistants that could be passed from one staff member to another.

  1 JCAHO’s 2006 National Patient Safety Goals: Handoffs are biggest challenge. 2 Passing the baton of care the patient relay, Australian Council for Safety and Quality in Health Care.   3,4 Handoff strategies in settings with high consequences for failure: lessons for health care operations, Emily S. Patterson, et al.