Statistics from Altmetric.com
In 2012, Massachusetts General Hospital (MGH) safety culture survey scores for handovers and transitions of care, though similar to the national median, were the lowest among all domains. Furthermore, based on safety reports and resident surveys, deficient handovers were not infrequently associated with preventable errors and adverse events. Although virtually all departments and divisions had some handover policy, there was no systematic, standardised, institution-wide approach.
These findings were also concerning given the educational mission of MGH, as there are Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements (VI.B.2 and VI.B.3) for resident competency in ‘effective, structured handover processes’.1 A previous study of MGH residents demonstrated that handovers often lacked important elements, and 59.4% of respondents reported that problematic handovers had contributed to major or minor patient harm.2
These considerations were the proximate stimulus for the MGH Center for Quality and Safety (CQS) to implement a comprehensive handover initiative using the I-PASS system.3–5
The handover problem
Handovers of patient care responsibility are ubiquitous in healthcare, affecting all practitioners in a myriad of different scenarios: nurses, residents, attending physicians and therapists; shift change, weekend coverage, night floats, off-service transitions, cross-service or cross-venue transfers; and inpatient–outpatient transitions.6 ,7 However, despite their central role in assuring safe and high-quality care, evidence from multiple sources demonstrates that healthcare handovers are often flawed or inadequate. Handoffs and transitions of care are typically among the lowest scoring domains in national summaries of Agency for Healthcare Research and Quality (AHRQ) safety culture survey scores (47% positive in 2014),8 and communication failures are a common cause of Joint Commission Sentinel Events9 and malpractice claims.10–12
Handovers have not evolved to meet the needs of contemporary practice
Healthcare handovers have always been suboptimal. However, their inadequacy has become more apparent and consequential in recent years, and the attention focused on them has commensurately increased,13–15 …
Contributors DMS, KMcE, LR, RGC, EM conceived and led the I-PASS initiative, collected and analysed data, and made critical manuscript revisions; DMS and RGC provided graphics; DMS drafted the original manuscript and revision, submitted the original manuscript and revision; and is responsible for the overall content.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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