Rationale / Evidence in Brief - Communication

Communication is the process by which information is exchanged between individuals and groups. A key element of the Joint Commission’s 8 tips for high-quality handoffs is to determine the critical information that needs to be communicated face-to-face and in writing. Individuals are encouraged to cover everything that is needed to safely care for the patient, and to do so in a timely fashion.1

It is also recommended that, when handing off care, information coming from many sources be combined and communicated at one time.1 When information is transferred, it should be done in both written and verbal formats. A handoff evaluation by Bhabra et al showed that only 33% of data transferred verbally was retained, which was increased to 92% when verbal handoff was accompanied by note-taking, and 100% when a computer-generated, pre-printed handover sheet was used.19

Face-to-face information exchange is the preferred type of verbal communication because it enables bidirectional and real-time interaction—questions can be asked and answered, and nonverbal cues can deepen information exchange. Written communication is also useful because it can assist the “sender” in organizing his or her thoughts, ensure key details are included, and allow the “receiver” to have a hard copy for reference and note taking.11

Computerized sign-out systems, in particular, have been associated with improved continuity of care and reduced AEs during patient handoffs. Similarly, handoff systems integrated within the EHR have been shown to assist with patient handoffs.20 Ideally, effective handoffs combine printed materials (automatically populated by the EHR, if possible) with written and verbal content.21 Verbal and written communication at the time of the handoff should result in a clear understanding by all parties about who is responsible for which aspects of the patient’s care.