Inter-shift handoff: Changes over a 6-year interval

To capture inter-shift handoff changes over a 6-year interval and to verify whether the handoff supporting system and aids (e.g., guidelines, training, and protocols) and environment really affect handoff performance.

A non-experimental cross-sectional research design. Data from the 2017 and 2011 surveys were used for comparisons.

A questionnaire survey was conducted among nursing staff in 31 general hospitals in 2017 and 4,282 staff responses were collected from inpatient wards such as internal medicine and surgery, the intensive care unit, emergency department and operating room. These were compared with the 1,182 responses collected in the previous 2011 survey.

Changes in the 6-year interval included the introduction of handoff guidelines and increased provision of training. The handoff approach changed significantly and relied more on electronic systems, especially in inpatient wards. However, there was no significant improvement in interruptions. Information transfer improvement was limited and only observed in the surgery wards. Significant correlations verified that in hospitals where nursing staff more positively evaluated the effectiveness of the guidelines, faced fewer interruptions and had more time, handoff performance was better overall, and a higher frequency of sufficient information transfer was evident.

Although the inter-shift handoff supporting system had great changes, improvement of information transfer occurred only in the surgery wards and was limited. It was verified that more effective handoff guidelines and a better handoff environment contributed significantly to improving inter-shift handoff performance.

This study addressed the question as to whether inter-shift handoffs have really improved. The answer is yes, but in a limited way. Based on the survey results and handoff practices in Japanese hospitals, a mixed approach (verbal, written, technological) is suggested for inter-shift handoffs. In addition, it is important to improve the current handoff procedures, guidelines and training.