Qual Saf Health Care doi:10.1136/qshc.2009.033480
  • Original research

The published literature on handoffs in hospitals: deficiencies identified in an extensive review

  1. P Brian Hilligoss
  1. School of Information, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Professor Michael D Cohen, School of Information, University of Michigan, 1085 South University Avenue, 312 West Hall, Ann Arbor, MI 48109-1107, USA; mdc{at}
  • Accepted 22 August 2009
  • Published Online First 8 April 2010


Background In hospitals, handoffs are episodes in which control of, or responsibility for, a patient passes from one health professional to another, and in which important information about the patient is also exchanged. In view of the growing interest in improving handoff processes, and the need for guidance in arriving at standardised handoff procedures in response to regulatory requirements, an extensive review of the research on handoffs was conducted.

Methods The authors have collected all research treatments of hospital handoffs involving medical personnel published in English through July 2008.

Results A review of this literature yields four significant conclusions: (1) the definition of the handoff concept in the literature is poorly delimited; (2) the meaning of ‘to standardise’ has not been developed with adequate clarity; (3) the literature shows that handoffs perform important functions beyond patient safety, but the trade-offs of these functions against safety considerations are not analysed; (4) studies so far do not fully establish that attempts at handoff standardisation have produced marked gains in measured patient outcomes.

Conclusion The existing literature on patient handoffs does not yet adequately support either definitive research conclusions on best handoff practices or the standardisation of handoffs that has been mandated by some regulators.


  • Funding Robert Wood Johnson Foundation Route 1 and College Road East, PO Box 2316, Princeton, NJ 08543, USA.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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