TABLE 1

Examples of the Project Change Package Applied Across the Common Handoff Types

Handoff Change Strategy Handoff Type
Shift-to-ShiftED-to-IPPeriop-to-IP
1. Defined handoff intentCreate a shared mental model among caregivers while maintaining the patient-centered approach
2. Defined handoff contentHandoff content based on:Handoff content based on:Handoff content based on:
1. Previous handoff safety events1. Observations of existing handoffs1. Core clinical assessment (SBAR/head to toe)
2. Core clinical elements2. Previous handoff safety events2. Surgical plan of care
3. Inclusion of patient/family3. Conceptual risks3. I-5 (I know what is wrong, what to do, when to worry, when to escalate, I see what you see)
3A. Standardized tools and methods5-P structured handoff (patient, plan, purpose, problems, precautions); consensus script5-P structured handoff (patient, plan, purpose, problems, precautions); consensus scriptStructured standardized handoff tool in SBAR format
3B. Standardized format for the handoffFace-to-face, in the patient roomReal-time, face-to-face handoffSynchronized, real-time, telephone handoff
3C. Clear and timely transition of responsibilityHandoff concludes with bedside safety checks; patient is safe and responsibility is transitionedAccepting physician’s summary affirms the “acceptance of responsibility” by the inpatient team.Receiving RN accepts patient via telephone (“I see what you see”). Patient arrives to unit and sending RN is available for questions via telephone.
4. Maximize team effectivenessSender/receiver education; active interviews regarding handoff quality and/or failuresSender/receiver education; active interviews regarding handoff quality and/or failures. Handoff leadership team engaged/available for issues of noncomplianceSender/receiver education; active interviews regarding handoff quality and/or failures. Collaborative revision of handoff tool; handoff leadership team engaged/available for issues of noncompliance (real-time feedback)
  • ED-to-IP, transition of a patient from the emergency department to the inpatient unit; Periop-to-IP, transition to/from the perioperative services to inpatient unit; RN, registered nurse; SBAR, situation, background, assessment, recommendations; Shift-to-Shift, representing handoffs between caregivers beginning or ending their shift.