Background: Communication failures during hospital handoffs are a leading cause of preventable medical errors, contributing to nearly two-thirds of sentinel events. Structured tools such as I-PASS have reduced medical errors by 23% and preventable adverse events by 30% in high-income settings, yet most low- and middle-income countries lack standardized handoff processes and research on this topic. Effective handoffs are critical to continuity of care, patient safety, and error reduction. This study explored provider perceptions and practices at two tertiary academic hospitals, Froedtert Hospital (U.S.) and Dhulikhel Hospital (Nepal), to identify context-specific barriers and opportunities for safer transitions of care.
Methods: A cross-sectional survey was administered to 62 hospitalists and staff physicians (42 Froedtert, 20 Dhulikhel) from May 2025 to October 2025. The survey included Likert-scale and open-ended questions assessing current handoff methods, satisfaction, perceived risks, and attitudes toward standardization. Quantitative data were analyzed descriptively using SPSS, and qualitative themes were used to contextualize findings.
Results: In Nepal, verbal handoffs were predominant (73.7%), while U.S. providers commonly used both verbal and written methods (45.9%), including email or EMR tools, and 30% used Verbal only.Both groups strongly favored structured handoffs that integrate verbal and standardized written communication, with over 80% supporting the use of templates, protected handoff time, and prioritization of high-risk patients. Satisfaction with current practices was lower in Nepal, with 25% satisfaction, compared to moderate satisfaction in the U.S (55%).At Froedtert, despite Epic availability, only 5.4% regularly used its handoff module, suggesting underutilization of existing. tools Key challenges included a lack of standardization, faculty variation on preferences and the content of handoff, and time constraints. Confidence in discharging patients on the first service day was low across both contexts, underscoring the need for more reliable, complete handoff information. In both settings, training new personnel in handoff practices was identified as essential.
Conclusions: Handoff challenges are universal but context-dependent. At Froedtert, even with EHR capability, a lack of standardized workflow limits consistency; at Dhulikhel, reliance on verbal exchanges fosters teamwork but raises omission risk. These findings reveal a global consensus on the need for standardized, interactive, and EMR-integrated handoff processes, while also highlighting the unique infrastructural and training challenges faced in resource-limited settings like Nepal. Developing adaptable, context-sensitive tools that blend digital standardization with team-based flexibility can strengthen communication, reduce preventable errors, and advance equitable care. This aligns with Sustainable Development Goal 3 and promotes bidirectional learning between high and low-income settings to improve global hospital safety through improved handoff standardization.