Improving Transitions - Handoffs Toolkit
A handoff is a “transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.”1 One of the key features that distinguishes a handoff from other types of communication about patients is that it establishes a transfer of responsibility or control.2
Key Driver Diagram
This toolkit on handoffs includes a detailed key driver diagram that is intended for teams to adopt and adapt to meet their project-specific needs and reflect their current system. As in the sample diagram below, teams may choose to focus their efforts on any combination of the Safe, Timely, Efficient, Effective, Equitable, Patient/family-centered, and Socially responsible (STEEEPS) criteria. The four primary drivers of Communication, Teamwork, Family Integration and Standardized Processes, and their corresponding potentially better practices (PBPs), serve to ensure the STEEEPS criteria are met for every handoff. Transition-specific drivers and change ideas provide a framework to link the PBPs to the specific focus on handoffs. Effective quality improvement efforts aimed at improving handoffs are likely to be short and focused, ideally accomplished over 90-120 days.
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.
Transition-Specific Drivers for Overarching Potentially Better Practices
- Determine the critical information that needs to be communicated face-to-face and in writing during each type of handoff [Primary Driver: Communication]
- Use bidirectional communication during all handoffs [Primary Driver: Communication]
- Include all team members when conducting a handoff, using the time to consult, discuss, and ask/answer questions (bidirectional communication) [Primary Driver: Teamwork]
- Include family members in handoffs and support them in participating in the process of providing information and asking/answering questions [Primary Driver: Family Integration]
- Standardize the tools and methods used to communicate handoffs [Primary Driver: Standardized Processes]
Each of these drivers are discussed in more detail in the following section, including suggestions for pertinent change ideas and possible measures for teams to consider. Much of the evidence focuses on handoffs at shift change, but many of the principles apply to change of service handoff, handoffs between different services (e.g., postoperative or preoperative handoffs, transport handoff), handoffs across settings (e.g., ED to NICU), or handoffs between professional health care providers and family caregivers at discharge.