Hospitalist Handoffs: a Systematic Review and Task Force Recommendations

Overview

Journal J Hosp Med

Publisher Wiley

Specialties General Medicine
Health Services

Date 2009 Sep 16

PMID 19753573

Citations 75

Authors

Vineet M Arora

Efren Manjarrez

Daniel D Dressler

Preetha Basaviah

Lakshmi Halasyamani

Sunil Kripalani

Affiliations

Soon will be listed here.

Abstract

Background: Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety.

Purpose: To develop recommendations for hospitalist handoffs during shift change and service change.

Data Sources: PubMed (through January 2007), Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network, white papers, and hand search of article bibliographies.

Study Selection: Controlled studies evaluating interventions to improve in-hospital handoffs (n = 10).

Data Extraction: Studies were abstracted for design, setting, target, outcomes (including patient-level, staff-level, or system-level outcomes), and relevance to hospitalists.

Data Synthesis: 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.

Conclusions: The systematic review and resulting recommendations provide hospitalists a starting point from which to improve in-hospital handoffs.

Citing Articles

Handoffs and transitions of care in the intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document.

Appelbaum R, Farrell M, Hoth J, Jung H, Pathak A, Nassar A Trauma Surg Acute Care Open. 2025; 10(1):e001677.

PMID: 39975963 PMC: 11836866. DOI: 10.1136/tsaco-2024-001677.

Improving and Sustaining Resident Physician Handover.

Reilly D, Shandilya S, Streater B, Aprile B, Aprile J Cureus. 2024; 16(2):e53413.

PMID: 38435200 PMC: 10908549. DOI: 10.7759/cureus.53413.

Daily handover in surgery: systematic review and a novel taxonomy of interventions and outcomes.

Ryan J, McHugh F, Simiceva A, Eppich W, Kavanagh D, McNamara D BJS Open. 2024; 8(2).

PMID: 38426257 PMC: 10905088. DOI: 10.1093/bjsopen/zrae011.

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

Franco Vega M, Ait Aiss M, Smith M, George M, Day L, Mbadugha A BMJ Open Qual. 2023; 12(4).

PMID: 37802542 PMC: 10565279. DOI: 10.1136/bmjoq-2023-002481.

Evaluation of a Standard Handover Tool at a Pediatric Tertiary Care Unit in Oman.

Al Riyami H, Al-Makhmari S, Al Balushi S, Al Abri S, Al Jabri M Cureus. 2023; 15(8):e43088.

PMID: 37680413 PMC: 10482360. DOI: 10.7759/cureus.43088.

References

Chu E, Reid M, Schulz T, Burden M, Mancini D, Ambardekar A . A structured handoff program for interns. Acad Med. 2009; 84(3):347-52. DOI: 10.1097/ACM.0b013e3181970829. View

Kannry J, Moore C . MediSign: using a web-based SignOut System to improve provider identification. Proc AMIA Symp. 1999; :550-4. PMC: 2232603. View

Williams R, Silverman R, Schwind C, Fortune J, Sutyak J, Horvath K . Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. Ann Surg. 2007; 245(2):159-69. PMC: 1877003. DOI: 10.1097/01.sla.0000242709.28760.56. View

Sidlow R, Katz-Sidlow R . Using a computerized sign-out system to improve physician-nurse communication. Jt Comm J Qual Patient Saf. 2006; 32(1):32-6. DOI: 10.1016/s1553-7250(06)32005-3. View

Ram R, Block B . Signing out patients for off-hours coverage: comparison of manual and computer-aided methods. Proc Annu Symp Comput Appl Med Care. 1992; :114-8. PMC: 2248075. View

Kripalani S, Lefevre F, Phillips C, Williams M, Basaviah P, Baker D . Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007; 297(8):831-41. DOI: 10.1001/jama.297.8.831. View

Petersen L, Orav E, Teich J, ONeil A, Brennan T . Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv. 1998; 24(2):77-87. DOI: 10.1016/s1070-3241(16)30363-7. View

Pothier D, Monteiro P, Mooktiar M, Shaw A . Pilot study to show the loss of important data in nursing handover. Br J Nurs. 2005; 14(20):1090-3. DOI: 10.12968/bjon.2005.14.20.20053. View

Patterson E, Roth E, Woods D, Chow R, Gomes J . Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care. 2004; 16(2):125-32. DOI: 10.1093/intqhc/mzh026. View

10.

Horwitz L, Krumholz H, Green M, Huot S . Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006; 166(11):1173-7. DOI: 10.1001/archinte.166.11.1173. View

11.

Singh H, Thomas E, Petersen L, Studdert D . Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007; 167(19):2030-6. DOI: 10.1001/archinte.167.19.2030. View

12.

Vidyarthi A, Arora V, Schnipper J, Wall S, Wachter R . Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. 2007; 1(4):257-66. DOI: 10.1002/jhm.103. View

13.

Van Eaton E, Horvath K, Lober W, Pellegrini C . Organizing the transfer of patient care information: the development of a computerized resident sign-out system. Surgery. 2004; 136(1):5-13. DOI: 10.1016/j.surg.2004.04.018. View

14.

Chaboyer W, McMurray A, Johnson J, Hardy L, Wallis M, Sylvia Chu F . Bedside handover: quality improvement strategy to "transform care at the bedside". J Nurs Care Qual. 2009; 24(2):136-42. DOI: 10.1097/01.NCQ.0000347450.90676.d9. View

15.

Van Eaton E, Horvath K, Lober W, Rossini A, Pellegrini C . A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. J Am Coll Surg. 2005; 200(4):538-45. DOI: 10.1016/j.jamcollsurg.2004.11.009. View

16.

Salerno S, Arnett M, Domanski J . Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward. Teach Learn Med. 2009; 21(2):121-6. DOI: 10.1080/10401330902791354. View

17.

Arora V, Johnson J, Lovinger D, Humphrey H, Meltzer D . Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005; 14(6):401-7. PMC: 1744089. DOI: 10.1136/qshc.2005.015107. View

18.

Lee L, Levine J, SCHULTZ H . Utility of a standardized sign-out card for new medical interns. J Gen Intern Med. 1996; 11(12):753-5. DOI: 10.1007/BF02598991. View

19.

Patterson E . Communication strategies from high-reliability organizations: translation is hard work. Ann Surg. 2007; 245(2):170-2. PMC: 1876978. DOI: 10.1097/01.sla.0000253331.27897.fe. View

20.

Halasyamani L, Kripalani S, Coleman E, Schnipper J, Van Walraven C, Nagamine J . Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists. J Hosp Med. 2007; 1(6):354-60. DOI: 10.1002/jhm.129. View