We’ve done many columns on the problems associated with handoffs in healthcare (see the listing and links at the end of today’s column). Handoffs are perhaps the most common transactions in hospital-based healthcare and are also among the processes most prone to error. We know that breakdowns in communication are contributing factors to 70% of all Sentinel Events in Joint Commission’s Sentinel Event database and many of those breakdowns occur during handoffs.
AORN (the Association of periOperative Registerd Nurses) has worked with the Department of Defense Patient Safety Program to develop a Perioperative Patient 'Hand-Off' Tool Kit. Though many of the principles are applicable to handoffs in any environment, these are tailored specifically for those occurring in the perioperative environment. Given that it was developed in conjunction with the DoD it is not surprising that it heavily incorporates materials from the TeamSTEPPS™ program.
The toolkit discusses the Joint Commission requirements for standardized handoff communications and stresses that handoffs should be held where there is adequate time, with minimal distraction, and allow for interactive discussion where the recipient is able to review all relevant material and has ample opportunity to ask questions. They stress the importance of using language that is clearly understood by all parties and use of “read-back”, “repeat-back” and “hear-back” to ensure that communication is understood by all parties. They also stress the importance of not only passing on information during a handoff but also passing on responsibility for care of the patient.
Structured handoff formats are discussed at length and examples of the various formats used in different hospitals are provided. These include SBAR, ISBAR, I Pass the Baton, PACE, and the 5 P’s. They do also note, as we have in the past, that a combination of verbal and written components in a handoff works better than either alone and they note the potential for use of information technology to enhance the handoff process.
These are good tools. In particular, if you are looking for a form, template or checklist to use in your perioperative handoffs you’ll probably be able to find it here.
Read about many other handoff issues (in both healthcare and other industries) in some of our previous columns:
May 15, 2007 “ ”
May 22, 2007 “ ”
August 28, 2007 “Lessons Learned from Transportation Accidents”
December 11, 2007 “Communication…Communication…Communication”
February 26, 2008 “Nightmares….The Hospital at Night”
September 30, 2008 “ ”
November 18, 2008 “ ”
December 2008 “Another Good Paper on Handoffs”.
June 30, 2009 “ ”
April 25, 2009 “ ”
April 13, 2010 “Update on Handoffs”
July 12, 2011 “Psst! Pass it on…How a kid’s game can mold good handoffs”
July 19, 2011 “Communication Across Professions”
November 2011 “Restricted Housestaff Work Hours and Patient Handoffs”
December 2011 “AORN Perioperative Handoff Toolkit”
February 14, 2012 “Handoffs – More Than Battle of the Mnemonics”
AORN. Perioperative Patient 'Hand-Off' Tool Kit.