A Hands-on Approach to Hand-offs

In “Developing Hand-off Standards for Hospitalists,” members of an SHM task force on hand-offs presented their findings from an extensive literature review and went on to propose basic standards for hospitalist hand-offs. The speakers included task force members Vineet Arora, MD, MA, assistant professor of medicine, University of Chicago; Lakshmi Halasyamani, MD, associate chairperson of the Department of Internal Medicine at St. Joseph Mercy Hospital in Ann Arbor, Mich.; Sunil Kripalani, MD, MSc, an instructor at Emory University, Atlanta, Ga.; and Efren Manjarrez, MD, assistant clinical professor of medicine at the Miller School of Medicine, University of Miami.

Vineet Arora, MD, MA

Vineet Arora, MD, MA

Literature Review: Slim Pickings

Although the group hoped to determine best practices based on a literature review of hand-offs, shift changes and handovers (excluding transitions in and out of hospitals) they couldn’t find enough appropriate research to support this goal.

After a PubMed search, and a review of the Agency for Healthcare Research and Quality’s (AHRQ) Patient Safety Net—which is a categorized, reviewed collection of articles and references—the task force reported the following: Of the 334 promising articles they initially identified, only 107 were deemed relevant after a title review. And of those, a significant article review found only 10 met the criteria for inclusion. Three studies of hand-offs appeared in nursing publications and were the only provider-specific studies. The remaining seven were studies of technology solutions for hand-offs—although all articles revealed that any technology fixes were “homegrown,” as nothing specific to hand-offs is widely available commercially.

Efren Manjarrez, MD

Efren Manjarrez, MD

Those 10 studies included few interventions, with no studies of hospitalist-specific hand-offs. Studies of shift changes predominated, and there were few studies that included patient outcomes.

“A summary of the literature supports the use of supplementing verbal hand-offs with written documentation in some structured format,” said Dr. Manjarrez. “It also showed a technology solution provided added benefits such as reduced rounding time and prep time and increased time with patients.”

The literature summary also suggests involving the patient in the hand-off conversation. “Signing out in front of the patient does wonders for your patient satisfaction rate,” remarked Dr. Manjarrez.

Lakshmi Halasyamani, MD

Lakshmi Halasyamani, MD

As part of the literature review, the task force found and examined five major expert consensus and policy white papers deemed relevant to hand-offs. Dr. Arora cited these papers from the Australian Council for Safety and Quality in Healthcare, the British Medical Association Junior Doctors Committee, the University Health Consortium, the Department of Defense Patient Safety Program, and the Joint Commission’s (formerly JCAHO’s) National Patient Safety Goal 2006.

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