Tool: Handoff

A handoff is a standardized method for transferring information, along with authority and responsibility, during transitions in patient care. Handoffs include the transfer of knowledge and information about the degree of uncertainty (uncertainty about diagnoses, etc.), response to treatment, recent changes in conditions and circumstances, and the plan (including contingencies).

In addition, both authority and responsibility are transferred. Lack of clarity about who is responsible for care and for decision making or exactly when the authority is being transferred have been major contributors to medical error (as identified in root cause analyses of sentinel events and poor outcomes).

When a team member is temporarily or permanently relieved of authority for a patient’s care, necessary information about the patient might not be conveyed. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. It maintains continuity of care despite changing caregivers and patients.

Many health systems are integrating electronic handoffs into their EHR systems to ensure they are complete, well documented, and accessible for review by the person assuming authority for the patient. While e-handoffs have potential benefits, particularly in virtual care or in settings where the person with authority is not present during the handoff, the e-handoff may be most effective when it is reinforced by direct communication between the two people involved.

How To Use a Handoff Effectively

A proper handoff includes the following:

• Transfer of responsibility and accountability: When handing off, it is your responsibility to know that the person who must accept responsibility is aware of assuming responsibility. Similarly, you are accountable until the other party is aware of the transfer of responsibility.
• Clarity of information: When uncertainty exists, it is your responsibility to clear up all ambiguity about responsibility before the transfer is completed.
• Appropriate communication of information: You must use appropriate communication channels and cannot assume that the person obtaining responsibility will read or understand the communication without confirmation.
• Acknowledgment by receiver: Until it is acknowledged that the handoff is understood and accepted, you cannot relinquish your responsibility. This step is particularly crucial for handoffs that occur electronically.
• Opportunity to ask questions and review: Handoffs are a good time to have a new pair of eyes evaluate the situation for both safety and quality. They should also allow questions that may allow the receiver to clarify key information or to call attention to issues that might have been overlooked.

In addition, handoffs include the transfer of knowledge and information about:

• The degree of certainty and uncertainty regarding a patient, such as whether a diagnosis has been confirmed.
• The patient’s response to treatment.
• Recent changes in condition and circumstances.
• The care plan, including contingencies.

Consider the following example of an effective handoff:

A second-year resident is handing off their patient to the night-team resident and shares that the patient is unstable; presents relevant background information, including the reason the patient was admitted; and notes ongoing issues and plans currently in place for the patient. The off-going resident also says the patient needs respiratory treatments every 2 hours, with arterial blood gas tests (ABGs) drawn after each treatment, and that those will need to be checked. The two residents review the contingency plans in place based on the patient's ABG results, including standing orders in place for the registered nurses to increase oxygen based on saturation levels and ABG results. The off-going resident then gives the receiving resident an opportunity to repeat the plan back and ask any questions.

TeamSTEPPS: Handoff (Subacute Care) (24 seconds)

Other options for expanding your understanding of handoffs include:

• Watch the following video example on handoffs in a long-term care setting. Afterwards, consider how you would answer these questions:
  • What went well in the handoff in this video?
    • Continuity of care was maintained.
    • Presenting symptoms and current assessment were communicated.
    • Actions taken so far were reviewed.
    • The face-to-face handoff allowed the sender to see the nonverbal communication from the receiver that confirmed the message had been received.
    • Verbal communication that the message had been properly received would have further confirmed that the receiver had the needed information and did not have any questions.

    While no handoff tool is perfect for every organization, choosing one standard approach and ensuring that all staff understand and use it when appropriate is preferable to having multiple handoff tools in active use.