Ratoinale / Evidence in Brief - Teamwork
It is critical to have all team members present during an effective handoff, and to create the conditions that allow them to exhibit the shared behaviors, attitudes, and cognitions necessary to accomplish the collective task of transferring care. A Six Sigma improvement project examining perioperative handoffs of neonates and pediatric cardiac patients found that communication errors were frequent in the postoperative handoff, and that the handoff process was negatively impacted by the fact that clinicians involved in a patient’s recent care did not consistently participate in the handoff.16
This emphasizes the importance of having all team members present at the time of a handoff. Qualitative data examining perceptions of handoffs that include physicians, nursing, and family revealed that families and nonphysician clinicians truly want the opportunity to be involved in physician-to-physician (or advanced practice provider to advanced practice provider) handoff.28
In their Handoff Clinical Report, the AAP encourages the entire team to be present (e.g., physicians, nurses, house staff, families) during handoff for high acuity or complex patients. They reason that by including the entire team, all individuals will appreciate that a new physician has assumed care of the patients. It also serves as an ideal time to address changes and ongoing concerns, and to directly observe the patient.21
In addition to the importance of having all team members present, it is important that the handoff facilitate effective teamwork. All members of the team must be able to use the handoff time to consult, discuss, and ask/answer questions; and they must be supported by a culture without hierarchy, so that care providers (regardless of level) are comfortable sharing information.11
Handoffs provide a mechanism to review patient information and discuss challenging cases. By using handoffs to “consult” with other providers, care is reviewed by multiple members of the team and potential errors are more likely to be identified, leading to improved care.21 Creating an environment that supports effective teamwork is also important. Having discussions in a quiet environment without distractions can enhance handoff communication.11 In addition, policies and reimbursement strategies that recognize the time needed to effectively handoff care are necessary.