Improving Peer to Peer Handoff Process at Service Change

Background: Handoffs are a part of inpatient medical care and can lead to patient care errors and threats to their safety.  Incomplete care transitions during service changes are associated with uncertainty of patient care plans. Current literature on handoffs focuses on day-night handoffs. Our project is intended to assess and improve handoffs at service change for hospitalists. 

Methods: Pre-intervention surveys were distributed to our academic hospitalist group in September 2013 to assess the need to modify service change handoff practices.  In response to the survey, we created a standardized sign-out template.  Six months later, we administered a post-intervention survey that included additional items assessing usefulness of the new template. We then integrated our hand offs into the electronic medical record and created a dot phrase which automatically populated our hand off template.  Starting June 2015, we added handoff audits completed by hospitalist faculty regarding the handoff received on the first day after transition of care. Using descriptive statistics, we analyzed the audit data for frequency of template use, completeness, and readability. Quarterly, faculty received feedback on their handoff quality.

Results: A total of 108 audits of handoffs were collected between June and November 2015.  For one of the patient charts audited, no handoff was provided.  Of the remaining 107 handoff audits, the handoff template was used in 95 (88.7%). The most commonly included elements included active consults (95.3%) and relevant disposition details (91%). The least commonly included elements included code status (87%) and a clear immediate action plan (89.7%).  Overall, faculty rated 78.5% of handoffs audited as easily readable and complete. Eleven (10.3%) of audits were rated as missing minor details and twelve handoffs audited (11.2%) were deemed as containing an excessive amount of detail.

Conclusions: In our single institution initiative, we have developed and implemented a service change handoff template and audit tool intended to provide feedback to the faculty and improve handoff methods through peer evaluations. Through our audits, the vast majority of hospitalist faculty are using the recommended template.  This may be due to the creation of a dot-phrase that easily includes the recommended components in the handoff.  The majority our faculty reviewers state that the handoffs they received were readable and contained the necessary details. Our next steps are to identify ways to improve inclusion of an immediate action plan in our handoffs and to target faculty who are identified as needing additional help in creating a succinct, relevant handoff.