Objective: To describe strategies employed during handoffs in four settings with high consequences for failure.
Analysis: of observational data for evidence of use of 21 handoff strategies.
Setting: NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto.
Main measure: Evidence of 21 handoff strategies from observations and interviews.
Results: Nineteen of 21 strategies were used in at least one domain, on at least an 'as needed' basis.
Conclusions: An understanding of how handoffs are conducted in settings with high consequences for failure can jumpstart endeavors to modify handoffs to improve patient safety.