Michael T Bigham1, Tina R Logsdon2, Paul E Manicone3, Christopher P Landrigan4, Leslie W Hayes5, Kelly H Randall6, Purva Grover7, Susan B Collins8, Dana E Ramirez9, Crystal D O'Guin10, Catherine I Williams11, Robin J Warnick12, Paul J Sharek13. 1. Divisions of Critical Care Medicine, and mbigham@chmca.org. 2. Children's Hospital Association, Overland Park, Kansas; 3. Hospitalist Division, and. 4. Department of Medicine, General Pediatrics, Children's Hospital Boston, Boston, Massachusetts; 5. Departments of Critical Care Medicine, and. 6. Performance Improvement, Children's of Alabama, Birmingham, Alabama; 7. Emergency Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio; 8. All Children's Hospital, Heart Center, St Petersburg, Florida; 9. Department of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia; 10. St Jude Children's Research Hospital, ICU, Memphis, Tennessee; 11. Patient Care Services, Children's National Medical Center, Washington, District of Columbia; 12. Children's Health Care of Atlanta, Atlanta, Georgia; and. 13. Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, andDivision of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Abstract
BACKGROUND AND OBJECTIVE: Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures. METHODS: Twenty-three children's hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS: Twenty-three children's hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]). CONCLUSIONS: Implementation of a standardized evidence-based handoff process across 23 children's hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction.
BACKGROUND AND OBJECTIVE:Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures. METHODS: Twenty-three children's hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS: Twenty-three children's hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]). CONCLUSIONS: Implementation of a standardized evidence-based handoff process across 23 children's hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction.
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