Handoffs_in_Hospitals_Draft_2010_09_20

Abstract

Background: In hospitals, handoffs are episodes in which control of, or responsibility for, a patient passes from one health professional to another, and in which important information about the patient is also exchanged. In view of the growing interest in improving handoff processes, and the need for guidance in arriving at standardized handoff procedures, a review of the research on handoffs is provided. Methods: The authors have attempted to identify all research treatments of hospital handoffs involving medical personnel published in English through July 2010. Results: Findings from the literature are organized into six themes: 1) The definition of 'handoff'; 2) The functions of handoffs; 3) The challenges and difficulties of handing off; 4) The costs and benefits of standardization; 5) Possible protocols for standardizing of handoffs; and 6) Questions needing answers, and methods of research. Conclusions: The large body of relevant literature shows handoff to be highly sensitive to variations in context, to be an activity that is essential for multiple important functions within a hospital that range far beyond patient safety, and to be subject to difficult tensions that necessarily attend efforts to standardize action within a highly differentiated hospital setting. In addition, there is little empirical evidence regarding the magnitude of the impact of handoff on patient safety and service quality, making the potential gains and complications from standardization uncertain.

Draft V9, September 2010 (Replaces V8, published January 2009)