Change Ideas - Teamwork

1. Conduct handoff or sign-out in a location that is free from interruptions (“sterile cockpit”).16

2. Designate a consistent and protected space for handoffs that allows team members to assemble and have access to information (e.g., near a computer).

3. Use simulation and debriefing to identify challenges and solutions for minimizing interruptions, ensuring flattened hierarchy, practicing situation awareness, and encouraging participation from all team members without reluctance during handoff.

  • Ensure simulations reflect real life practice (e.g., handing over many patients, handoff in an imperfect environment, etc.)

4. If appropriate, hold a team discussion for handoff with the incoming and outgoing multi-disciplinary teams.16,25 Define the team members that should be present for the handoff. Consider the following:

  • Include residents, fellows, advanced practice providers, and attending physicians for shift change.
  • Include bedside nursing, surgery, anesthesia, neonatology, respiratory therapy, and charge RN for perioperative handoff.
    • Have anesthesiologist and surgeon stay at the bedside until the first vital signs are obtained29
  • Divide the content into specialty-specific sections so that all team members participate

5. For perioperative handoffs, use a handover protocol that draws on key elements of effective teams (e.g., aviation, Formula 1 pit crews).18

6. Encourage a culture with a flattened hierarchy so that care providers (regardless of level) are comfortable sharing information.

7. Encourage a culture where all team members assume responsibility for maintaining the integrity of a handoff environment that is free from interruption, with only patient-specific conversation.

8. Establish policies and guidelines to ensure handoffs take priority over all other duties other than emergencies.

9. Ensure schedules allow overlap time between outgoing and on coming shifts to decrease the chance that high quality handoffs are disincentivized, and to enable all team members to be present.21,26

10. Ensure the transfer of responsibility is communicated to the entire team by making up-to-date contact information easily accessible (e.g., using a whiteboard).