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Quality improvement report
An institution-wide handoff task force to standardise and improve physician handoffs
  1. Leora I Horwitz1,2,
  2. Kevin M Schuster3,
  3. Stephen F Thung4,
  4. David C Hersh5,
  5. Rosemarie L Fisher1,
  6. Nidhi Shah6,
  7. William Cushing6,
  8. Judy Nunes3,
  9. David G Silverman7,
  10. Grace Y Jenq1
  1. 1Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
  3. 3Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4Department of Obstetrics/Gynecology, Ohio State University, Columbus, Ohio, USA
  5. 5Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
  6. 6Hospitalist Service, Yale New Haven Hospital, New Haven, Connecticut, USA
  7. 7Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Leora Idit Horwitz, Section of General Internal Medicine, PO Box 208093, New Haven, CT 06520-8093, USA; leora.horwitz{at}yale.edu

Abstract

Background Transfers of care have become increasingly frequent and complex with shorter inpatient stays and changes in work hour regulations. Potential hazards exist with transfers. There are few reports of institution-wide efforts to improve handoffs.

Methods An institution-wide physician handoff task force was developed to proactively address issues surrounding handoffs and to ensure a consistent approach to handoffs across the institution.

Results This report discusses the authors' experiences with handoff standardisation, provider utilisation of a new electronic medical record-based handoff tool, and implementation of an educational curriculum; future work in developing hospital-wide policies and procedures for transfers; and the authors' consensus on the best methods for monitoring and evaluation of trainee handoffs.

Conclusion The handoff task force infrastructure has enabled the authors to take an institution-wide approach to improving handoffs. The task force has improved patient care by addressing handoffs systematically and consistently and has helped create new strategies for minimising risk in handoffs.

  • Handoff
  • transition of care
  • sign-out
  • internship and residency
  • quality improvement
  • communication
  • duty hours/work hours
  • hand-off
  • transitions in care
  • surgery
  • safety culture
  • quality improvement

https://doi.org/10.1136/bmjqs-2011-000658

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    Footnotes

    • Funding Dr Horwitz is supported by the National Institute on Aging (K08 AG038336) and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. Dr Horwitz is also a Pepper Scholar with support from the Claude D Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA). No funding source had any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, the National Institutes of Health or the American Federation for Aging Research.

    • Competing interests None.

    • Ethics approval As a quality improvement project involving systems changes institutional review board (IRB) approval was not required. However, we did obtain IRB approval to review utilisation data for sign-out notes.

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