Distractions, Lack of Standardization Can Hinder Handoff Process

A quality improvement team was able to increase satisfaction and efficiency in the handoff process by standardizing the format and minimizing distractions, according to a study published in the Journal of Hospital Medicine.

“The reliability and efficiency of the handoff process is a national and local concern,” said M. Caroline Burton, MD, and colleagues from Division of Hospital Internal Medicine at the Mayo Clinic. The authors set out to study the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants; most studies, they wrote, have focused on physicians-in-training.

In the study, Burton and colleagues identified four problems: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in-room conversations), and poor communication. They restructured the process and observed post-intervention behavior at 15 and 90 days, conducting participant-provider surveys before and after regarding wasted time, total time-in-report, and satisfaction with the process.

Prior to the intervention, 60.5% of providers said they believed morning handoff was performed in a timely fashion, compared to 100% post-intervention. The average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention; before the intervention, 6.5 minutes were believed to be wasteful, compared with 0.5 minutes post-intervention.

The authors were able to identify and address deficiencies in the handoff process by enhancing the physical environment (with a smaller room, noise reduction, and closed door); assigning seating (through visual cues by table tent cards); providing printed materials to non-clinicians; standardizing written updates and team times (with a consistent and precise daily time for each team report); implementing a culture change, including deference of attention to team receiving report with opportunity for questions; and minimizing side conversations. “This intervention package,” they wrote, “resulted in an improvement in satisfaction and timeliness of clinicians involved.”

For more:

• Journal of Hospital Medicine—Hospitalist handoffs: A systematic review and task force recommendations
• Handoffs Causing Patient Harm: A Survey of Medical and Surgical House Staff
• Institute for Healthcare Improvement (IHI) Perioperative Patient Handoff Tool Kit