Spotlight on: Handoffs

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September 8, 2015 by dailybolusoflr

Spotlight on: Handoffs

Contributors: Kamna Balhara MD, Jeremiah Hinson MD PhD, Binoy Mistry MD,
Sarah Stewart de Ramirez MD MPH, James Scheulen PA MBA

On behalf of the Johns Hopkins Global Emergency Services FAST


Handoffs represent a perilous time for patient safety. Standardized handoffs have been proposed to be an effective solution in reducing communication errors that could lead to patient safety issues.
In preparation for this, we have examined certain pitfalls in communication and possible solutions, which we should all be aware of in our handoff practices, both at shift change and during handoff to admitting physicians.

1. Standardized handoff: important but not prevalent (Kessler et al, Am J Med Qual, 2014)
a.     Majority of EM PDs in CORD survey report that no standardized handoff protocol exists
                                                    i.     Use .handoff forms in EPIC and standardized format of AM handoffs with blue/red teams and attendings

2. Common errors in EM handoffs to internal medicine (Horwitz et al, Ann Emerg Med, 2009) that are also applicable to ED change-of-shift handoff
a.     Failure to communicate vital signs
                                                    i.     Recent study (Venkatesh et al, Ann Emerg Med, 2015) observed >1000 patient handoffs at ED change-of-shift and found that, in of 1 of 7 patients, hypotension and hypoxia were not communicated (independent of ED crowding at time of handoff)
b.     Failure to communicate physical exam
c.      Who is responsible for vital signs/lab tests that result after handoff has taken place but patient is still in ED?
d.     Ambiguous assignment of responsibility regarding tests ordered after handoff
e.     EM providers provide stabilization/provisional diagnosis/disposition and IM providers may expect final diagnosis
                                                    i.     Importance of interactive handoff to align expectations


Examples of Handoff Tools in the Literature

Ref: http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/safety+and+quality/clinical+handover/isbar+-+identify+situation+background+assessment+and+recommendation



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