Warm Handoffs: a Novel Strategy to Improve End-of-Rotation Care Transitions

Abstract

A warm handoff protocol represents a novel strategy to potentially mitigate the known risks associated with end-of-rotation care transitions. Additional studies analyzing patient outcomes will be needed to assess the impact of this strategy.

Improving end-of-rotation transitions of care among ICU patients

“…Second, the ‘culture’ of this handoff is different, making an already complex, time-consuming strategy even more difficult to systematically implement 4 5 41 42. The key differences are that physicians who are transitioning off service are frequently transitioning to other rotations or vacation, as are physicians rotating on service, making an in-person handoff logistically more difficult to accomplish even if preliminary data suggest residents value in-person end-of-rotation handoffs 32. Further, since these physicians are permanently transitioning responsibility to another team, an attitude of ‘out of sight, out of mind’ must be addressed.…”

“…The intervention was developed using previously published data on care transitions4 5 31–33 and informed by three resident and nursing focus groups conducted before the study period aimed at determining current practice patterns and expected limitations. The intervention included four separate components aimed to be patient centred, multidisciplinary and pragmatic: (1) in-person bedside handoff (including patient/family if possible), (2) bedside handoff checklist, (3) nursing presence at handoffs, and (4) 30 min education sessions for residents instructing them in the new process.…”

“…In-person bedside handoff took the form of a structured interaction at the patient’s bedside with the nurse present using a checklist to ensure completeness of handoff for each patient. The checklist used for bedside handoff (online supplementary material 1) was adapted for an ICU setting from a prior publication using a similar checklist to transition care at the end of the house staff rotation 32. One novel component, termed the ‘diagnostic certainty score’, was included in this checklist.…”

“…Surveys were administered monthly to internal medicine residents at the beginning of each rotation following service change via in-person and email administration, while attending and nursing surveys were administered at three occurrences to entire staff: baseline, following intervention 1 and at completion of intervention 2. All survey questions were developed using prior publications on transitions in care31–33 35 36 and tested using an iterative review process with local stakeholders, institutional survey design experts and non-study clinicians (online supplementary material 2). For all resident, nurse and attending surveys, per cent positive response (agreement) was created from collapsing other categories.…”

Incorporating Continuity in a 7-On 7-Off Hospitalist Model and the Correlation With Patient Handoffs and Length of Stay

“…8,9 There has been an increased effort to improve communication at academic institutions using standardized verbal and written handoff tools. 10,11 As most hospitalist models limit the number of consecutive days worked by a physician and have separation of admitting and rounding roles, additional handoffs and errors can occur.…”