Handoffs Toolkit - Measures

The measures that each team chooses will depend on their own local improvement plans and availability of data, and should be framed around the improvement work that is planned. Measures should not only track process changes related to handoffs, but should also focus on the core PBPs related to Communication, Teamwork, Family Integration and Standardized Processes.

Patterson et al suggest a conceptual framework for identifying handoff measurement tools based on handoff functions.10

Click to view table

Below is a list of more specific potential measures for your team to consider in the context of your handoff project. We strongly encourage you to be parsimonious. Teams are encouraged to focus on measures that they feel will best capture the impact of their work. In many cases, teams may need to perform direct observation of handoffs in order to assess the quality of these transitions.

Safety Measures

  • Medical Errors
  • Preventable Adverse Events
  • Near Miss Errors

 

Effectiveness Measures

  • Provider self-report of:10
    • Satisfaction with handoffs
    • Perceived quality of handoffs
    • Critical incidents attributed to inadequate transfer
    • Patient harm experienced from problematic handoff (in most recent shift)
    • Experience of surprises in following shift

 

Efficiency Measures

  • Handoff Time (minutes/patient)
  • Time spent updating written sign-out documents (minutes/patient or minutes/day)

 

Communication Measures

  • Adherence to Standard Handoff Content
  • Percent of handoffs where EHR handoff report is run
  • Number of EHR handoff reports printed per month
  • Percent of staff reporting that handoff was very accurate
  • Number of errors per patient (verbal handoff)
    • Errors of omission (core data element absent in sign-out)
    • Errors of commission (core data element incorrect or incomplete in sign-out)
  • Number of errors per patient (written handoff)
    • Errors of omission (core data element absent in sign-out)
    • Errors of commission (core data element incorrect or incomplete in sign-out)
  • Subjective acceptability of conveyed content (assessment made by observer)
  • Percent of handoffs with face-to-face verbal communication
    • Percent of handoffs with evidence of bi-directional communication

 

Teamwork Measures

  • Percent of handoffs free of interruptions and background distraction
  • Number of interruptions per handoff
  • Number of clarification and error-detection questions posed by oncoming provider

 

Family Integration

  • Percent of shift handoffs where parents were present
  • Percent of shift handoffs where parents’ insight was sought out
  • Percent of shift handoffs where parents contributed

 

Standardization

  • Percent of handoffs using the selected standardized handoff tool
  • Percent of handoffs including all components of the standardized handoff tool
    • Example: Proportion of handoffs where verbalized illness severity, patient summary, and action list components of handoff were discussed
    • Example: Proportion of handoffs for watcher or unstable patients where situation awareness and synthesis of information components of handoff were included

 

Click here for an example rating tool (self-rating and external rating) for handoff quality