Decreasing Handoff-Related Care Failures in Children’s Hospitals

Abstract

BACKGROUND AND OBJECTIVE: Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures.METHODS: Twenty-three children' s hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS:Twenty-three children' s hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P , .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P , .05]; clear transition of responsibility from 92% to 96% [P , .05]; and minimized interruptions and distractions from 84% to 90% [P , .05]) as did overall satisfaction with the handoff (from 55% to 70% [P , .05]).CONCLUSIONS: Implementation of a standardized evidence-based handoff process across 23 children' s hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction. Pediatrics 2014;134: e572-e579 AUTHORS:

Changes in Efficiency and Safety Culture After Integration of an I-PASS–Supported Handoff Process

“…6,9,18,19 However, these studies did not specifically measure the potential benefit on the efficiency of care delivery often associated with standardization in high-reliability systems. 20 A small number of studies have measured handover time as a balancing metric; these 5 …”

“…5 Most notably, the implementation of the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver)-supported handoff bundle studied with resident-to-resident handoffs has shown reductions in medical errors and preventable adverse events. 1,[6][7][8] Although previous reports have shown important benefits in standardizing handoffs, there is little information available reflecting the association of standardized handoff process with efficiency and culture of safety. One recent report found that a standardized communication process was not associated with an increase in time for handoff between the operating room and the recovery room.…”

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

“…The panel evaluated the existing literature and adopted tools and change concepts from previous discharge programs. 2, 3, 8 -11, 30 They also incorporated lessons learned e2 20 This panel developed a change package covering 6 broad areas, which included the following strategies:…”

Building a Culture of Safety in Pediatrics and Child Health

“…Child health professionals care about the clinical outcomes of the children they look after. A culture of safety should ensure that they should have robust, timely data that can act as a feedback loop on their performance [21].…”

“…The handover is critical, as it requires transfer of clinical information and responsibility between teams. A recent study in 23 US hospitals [21] showed that a standardized handover process could significantly reduce handover failures from a baseline of 25 % to just fewer than 8 %. Ideally, the handover process or bundle needs to be embedded within the electronic medical record.…”