A Model for Building a Standardized Hand-off Protocol

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Article-at-a-Glance

Background

The Joint Commission has made a “standardized approach to hand-off communications” a National Patient Safety Goal.

Method

An interactive 90-minute workshop (hand-off clinic) was developed in 2005 to (1) develop a standardized process for the handoff, (2) create a checklist of critical patient content, and (3) plan for dissemination and training.

Conclusion

To date, 7 of 10 residency programs have participated. Analysis of these protocols demonstrated that the hand-off process is highly variable and discipline-specific. Although all disciplines required a verbal handoff, because of competing demands, verbal communication did not always occur. In some cases, the transfer of professional responsibility was separated in time and space from the transfer of information. For example, in two cases, patient tasks were assigned to other team members to facilitate timely departure of a postcall resident (to meet resident duty-hour restrictions), but results were not formally communicated to anyone. The hand-off clinic facilitated the incorporation of “closed-loop” communication by requiring that follow-up on these tasks be conveyed to the on-call resident.

Discussion

This model for design and implementation can be applied to other health care settings.

Section snippets

Creating a Model for Standardized Handoffs

The handoff can be thought of as a communication of information (content) that can take place through different modalities, which can include a written or verbal component. Two guiding principles underlie this model. First, the standardized protocol for handoffs needs to be tailored to discipline and organization. That is, recognize that what works in one discipline may not work in another, given each discipline’s unique requirements. Furthermore, what constitutes an effective handoff for one

Findings from the University of Chicago Hospitals

We offered the hand-off clinic to individual residencies that take in-house call on an inpatient service. The workshop employs a semistructured interview of residents to do the following:

  • Develop a standardized process for the handoff using a process mapping methodology.

  • Create a checklist of critical patient content.

  • Plan for dissemination and training.

To date, 7 of 10 residency programs have participated. We used process analysis to highlight similarities, differences, and areas for improvement

Conclusion

The model to standardize the handoff has the potential to result in improved patient care. Mapping the process and building a standardized checklist of content can facilitate meeting the Joint Commission National Patient Safety Goal. Using opinion leaders and involving residents can be crucial to the success of disseminating the standardized hand-off protocol to resident physicians in an academic teaching hospital.

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    We attempted to standardize the format of sign-out, to provide an expected framework for physicians in the ED to provide TOC. In contrast to SBAR, SHOUT, IPASS, and SIGNOUT [9], we utilized an individually tailored framework for our ED, as “the standardized protocol for handoffs needs to be tailored to discipline and organization” [3]. Our formatted TOC had only slight modifications compared to the process we noted on the “current state” flow map prior to initiation of the study.

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Department Editors: Marcia M. Piotrowski, R.N., M.S., Peter Angood, M.D., Paula Griswold, M.S., Gina Pugliese, R.N., M.S., Sanjay Saint, M.D., M.P.H., Susan E. Sheridan, M.I.M., M.B.A., Kaveh G. Shojania, M.D. Readers may submit National Patient Safety Goals inquiries and submissions to Steven Berman ([email protected]) and Marcia Piotrowski ([email protected]).

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