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Handoffs: what’s good for residents is good for nurses…so what’s next?
  1. Rebecca R Kitzmiller1,
  2. Sim B Sitkin2,
  3. Arpana R Vidyarthi3
  1. 1 School of Nursing and Faculty, Carolina’s Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2 Fuqua School of Business and Sanford School of Public Policy, Center on Leadership and Ethics, Duke University, Durham, North Carolina, USA
  3. 3 Duke-NUS Medical School, Advanced Internal Medicine, National University Health System, Singapore
  1. Correspondence to Dr Rebecca R Kitzmiller, School of Nursing, and Faculty, Carolina’s Health Informatics Program, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27515, USA; kitzm002{at}

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Communicating patient information at shift change is a time-honoured nursing tradition. Historically referred to as ‘giving report’, the methods and information shared during nursing handoffs varied widely in modality (eg, face to face or through audio recordings), location (eg, in the break room, unit work centre or bedside) and format (eg, notes, formatted document or electronic health record). Although the shift change handoff process has evolved to increasingly emphasise face-to-face exchange and required data elements, variability persists,1 and the shift transition remains a vulnerable time for patients.

Shift changes generally, and the nursing handoff specifically, create gaps in care where errors may occur. In this issue of BMJ Quality and Safety, Starmer and colleagues2 describe a framework, IPASS, to bridge this gap. IPASS stands for  I llness severity;  P atient summary,  A ction list;  S ituation awareness and contingency planning; and  S ynthesis by receiver. IPASS is a handoff improvement bundle that provides a standardised structure to the information exchanged at shift change. This work joins a growing literature that demonstrates the positive effects gained from standardising communication content and delivery methods.3 The IPASS bundle was initially studied in paediatric residents across the USA4 and was adapted by Starmer et al 2 for use by nurses in a paediatric intensive care unit. These researchers found that implementation of this bundle increased the frequency, quality and efficiency of key handoff elements, including fewer interruptions during nursing shift change.2 Collectively, these findings suggest that …

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