Evaluating handoffs in the context of a communication framework.

Area of Science:

• Healthcare Quality and Safety
• Medical Communication
• Surgical Patient Care

Background:

• Mandated resident duty hour restrictions have increased patient handoffs.
• This rise in handoffs creates more opportunities for errors during care transitions.
• Existing research on handoffs is largely empirical, lacking a structured framework.

Purpose of the Study:

• To evaluate the surgical patient handoff process within a published communication framework.
• To identify factors impacting handoff efficiency and quality.
• To assess rater consistency in evaluating handoffs.

Main Methods:

• A prospective, single-institution study observed 126 surgical patient handoffs.
• Evaluation tools were developed for sources, receivers, and observers.
• Data were analyzed using correlations and multivariate linear regressions; rater consistency was assessed with intraclass correlations.

Main Results:

• Handoffs averaged 9.2 patients and lasted 9.1 minutes, with 4.7 distractions.
• Fatigue and extraneous staff were common distractions.
• Active electronic devices, teaching discussions, and hierarchy negatively impacted handoff quality.

Conclusions:

• Studying handoffs within a framework reveals communication barriers.
• Distractions and source-receiver relationships significantly affect handoff quality.
• Findings support targeted interventions to improve handoff effectiveness and patient safety.