TABLE 1.
Characteristics of studies included in the review.
| Author and year | Country | Setting | Study design | Participants | Type of handoff | Interventions | Outcomes and results |
|---|---|---|---|---|---|---|---|
| Airan-Javia 2012 | United States | Academic center (multi-hospital) | Pre/post | Internal Medicine residents | Shift | Didactic lecture content | Recall of code-related communication failures: 22.3% pre vs. 4% post, p = 0.001 Percentage of communication failures related to overnight tasks: 8.8 pre vs. 2.4 post, p = 0.03 |
| Akhunbay-Fudge 2014 | United Kingdom | Community teaching (single hospital) | Pre/post | Internal Medicine residents | Weekend | Introduced new “proforma” | Difficulty understanding patient notes (on a 10-pt scale): 5.7 pre vs. 0.8 post, no p-value reported Time to find ceiling of care (sec): 153 pre vs. 5 post, no p-value reported |
| Alolayan 2017 | Saudi Arabia | Academic center (single hospital) | Pre/post | Oncologists | Shift | Outside of EMR electronic intervention, Setting best practices/guidelines, Advertising campaign, Email reminders | Length of stay: Reported in run chart; no p-value reported |
| Atkinson 2015 | United States | Academic center (single hospital) | Pre/post | Surgery residents, Surgery fellows | Shift | Within EMR electronic intervention | Handoff associated adverse event: 1 pre vs. 0 post, no p-value reported Satisfaction score: 7.5 pre vs. 7.5 post, no p-value reported Frequency of AM information not communicated: 3.2 pre vs. 2 post, no p-value reported |
| Clanton 2017 | United States | Academic center (single hospital) | Randomized trial | Surgery residents | Shift | Standard scheduled face-to-face handoff, Setting best practices/guidelines, Role-playing/simulation, “Training and education” in addition to simulation. | Mortality (per 100 admissions): 4.3 focused vs. 3.8 formal, p = 0.392 Any adverse event (per 100 admissions): 17.5 focused vs. 15.9 formal, p = 0.118 Any negative event: 23.6 focused vs. 22.9 control, p = 0.556 ICU LOS (d): 6.53 focused vs. 5.92 formal, p = 0.727 LOS (d): 5.88 focused vs. 5.50 formal, p = 0.024 Duration of handoff (min): 6.7 focused vs. 20.6 formal, p < 0.001 |
| Culwick 2014 | United Kingdom | Community teaching (single hospital) | Pre/post | Surgery residents | Weekend | Outside of EMR electronic intervention | Satisfaction with handover system: 7.1% pre vs. 85.7% post, no p-value reported Average time to locate a patient (sec): 21 pre vs. 4 post, no p-value reported |
| Dean 2018 | United Kingdom | Academic center (single hospital) | Pre/post | Surgery residents | Weekend | Outside of EMR electronic intervention, Residents asked to use a standardized paper handoff document, and patient-level data tracked in EMR | LOS: 10.21 pre vs. 8.67 days post, p = 0.0356 Weekend discharges: 39.07 pre vs. 48.93 post, p = 0.0034 Cost savings associated with reduced LOS (Not reported as a formal outcome, however the authors do extrapolate based on reduced LOS) |
| Din 2012 | United Kingdom | Academic center (single hospital) | Pre/post | Surgery junior doctors, registrars, and nurses | Weekend | Outside of EMR electronic intervention, Written reference materials (verbal, email, and poster communication) | Discharge over weekend: 5% pre vs. 20% post, no p-value reported Average hours spent on ward rounds: 3.5 pre vs. 3 post, no p-value reported Confidence in handoffs: 65% pre vs. 78% post, no p-value reported |
| Fryman 2017 | United States | Academic center (single hospital) | Several PDSA cycles | Internal Medicine residents | Shift | Didactic lecture content | Adverse events: χ2 4.8, p = 0.04 Events that should have been anticipated or discussed during handoff but were not: χ2 9.6, p = 0.003 |
| Gagnier 2016 | United States | Academic center (single hospital) | Pre/post | Surgery residents | Shift | Significant educational component in the development of the handoff. Also notes that residents were “briefed” | Any adverse events: 59.7% pre vs. 51.7% post Number of events per patient: 1.02 pre vs. 0.75 post, no p-value reported Hospital stay in mean days: 3.33 pre vs. 2.85 post Incidence risk ratio of control vs. test for adverse event in adjusted modified Poisson regression: 0.727, p = 0.044 Time to complete handoff: 3 doctors/60%, 1/20%, vs. 9 doctors 60%/2 doctors 13% in the 10 min vs. 30 min categories, no p-value reported |
| Gardezi 2014 | United Kingdom | Community teaching (single hospital) | Pre/post | Internal Medicine residents | Weekend | Implementation of checklist for handoff | Number of pages over the weekend for elements of the checklist: 83 pre vs. 32 post, no p-value reported |
| Gibbons 2016 | Ireland | Academic center (single hospital) | Several PDSA cycles | Surgery faculty and residents | Weekend, Other | Didactic lecture content | Weekend discharges: 10.6% pre vs. 14.8% post, p < 0.05 Length of stay: 13.0 days pre vs. 5.4 days post, p < 0.05 Emergency response team calls: 7 pre vs. 4 post, no p-value reported Re-admissions: 0 pre vs. 0 post, no p-value reported |
| Goldraij 2021 | Argentina | Community nonteaching (single hospital) | Pre/post | Palliative care faculty | Shift | Didactic lecture content | Percentage of families reporting patient comfort over night: 65% pre vs. 87% post, no p-value reported |
| Graham 2013 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents | Shift | Within EMR electronic intervention, Standard scheduled face-to-face handoff | Adverse events: IRR 0 (0, 3.11), p = 0.41 Near misses: IRR 0 (0, 1.04), p = 0.056 |
| Huth 2016 | Canada | Academic center (single hospital) | Pre/post | Pediatrics residents | Shift | Setting best practices/guidelines, Role-playing/simulation, Didactic lecture content, Written reference materials, Advertising campaign | Handoff duration: Decreased by 1.7 min (p = 0.38) |
| Kenny 2014 | United Kingdom | Community teaching (single hospital) | Pre/post | Surgery residents | Shift | Outside of EMR electronic intervention | Overall satisfaction: 0% pre vs. 100% post, no p-value reported Daily time updating the list (min): 95 pre vs. 53 post, no p-value reported |
| Krowl 2018 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents | Shift | Didactic lecture content, small group learning | Number of rapid responses initiated per day: 1.05 pre vs.0.98 post, p = 0.345 |
| Lee 1996 | United States | Academic center (single hospital) | Randomized trial | Internal Medicine residents | Shift | Standardization of handoff card | LOS (days): 4.6 control to 5 intervention, no p-value reported Poor sign out (assessed nightly): 14.9% control vs. 5.8% intervention, p = 0.016 |
| Lo 2016 | United States | Teaching (single hospital) | Pre/post | Pediatric hospitalists | Shift | Within EMR electronic intervention, Email reminders, Written reference materials | Median total handoff time (min): 84 pre vs. 61 post, p < 0.001 |
| Mueller 2016 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents, Surgery residents | Shift, Service | Outside of EMR electronic intervention | Total Medical Errors: Decreased, IRR 0.49 (0.42–0.58), p < 0.001 Medical errors owing to mistakes in handoff (per 100 patient days): 2.47 pre vs. 0.95 post, p < 0.001 |
| Nabors 2015 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents | Shift | Within EMR electronic intervention, Setting best practices/guidelines | Duration of sign out (minutes): 25.5 pre vs. 22.7 post, p = 0.0338 |
| Patel 2014 | United Kingdom | Teaching (single hospital) | Pre/post | Psychiatry residents | Weekend | Within EMR electronic intervention | Mortality rate: 16.5% pre vs. 12.5% post, no p-value reported Percentage of deaths during weekend (OR): 0.37, p = 0.07 |
| Payne 2012 | United States | Academic center (single hospital) | Non-randomized parallel | Internal Medicine residents | Shift | Outside of EMR electronic intervention | Near-miss events as perceived by the physician: 55% control vs. 31.5% intervention, p = .0341 |
| Pennell 2017 | United Kingdom | Teaching (single hospital) | Pre/post | Multidisciplinary | Shift | Standard scheduled face-to-face handoff, Setting best practices/guidelines, Multidisciplinary handoff | Handoff Duration (minutes): 17 pre vs. 23 post, p = 0.041 |
| Petersen 1998 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents | Shift | Outside of EMR electronic intervention | Preventable adverse event: 1.71% pre vs. 1.23% post, no p-value reported Preventable adverse events during cross coverage: 6 pre vs. 9 post, p > 0.10 |
| Piscioneri 2011 | Australia | Teaching (single hospital) | Pre/post | Surgery faculty and residents | Shift, Weekend | Standard scheduled face-to-face handoff | Completion rate of tertiary trauma survey: 29.6% pre vs. 86.1% post, no p-value reported Time from admission to tertiary survey (hours): 30.6 pre vs. 32.8 post, no p-value reported |
| Rao 2012 | Australia | Academic center (single hospital) | Pre/post | Internal Medicine residents | Shift | Outside of EMR electronic intervention, setting best practices/handoffs | Weekend discharges: 14.2% pre vs. 20.39% post, p < 0.001 Emergency medical calls: 7.47% pre vs. 5.49 post, p = 0.01 |
| Raval 2015 | United States | Academic center (single hospital) | Pre/post | Surgery faculty and residents | Shift | Moved from Microsoft access directory to moving handoff into Epic. | Codes outside of ICU: 2 pre vs. 3 post, p = 0.65 Serious safety events: 3 pre vs. 0 post, p = 0.08 Adverse drug event related to abx prescribing: 3 pre vs. 1 post, p = 0.32 Readmission rate: 3.0% pre vs. 2.9% post, p = 0.85 GI surgery infection rate: 6.3% pre versus 4.0% post, p ≤ 0.01 Average time spend on list maintenance per person per week in min.: 155.75 pre vs. 112.59 post, p = 0.16 |
| Sadiq 2021 | United Kingdom | Academic center (single hospital) | Pre/post | Surgery faculty and residents | Shift | Advertising campaign | Length of trauma handover (in minutes): 19.5 pre vs. 23.8 post, p = 0.26 Length of admissions handover (in minutes): 19.7 vs. 24.3, p = 0.28 |
| Salerno 2009 | United States | Teaching (single hospital) | Pre/post | Psychiatry, Family Medicine, and Transitional Year interns | Shift | Didactic lecture content | Sign out accuracy (day to night): 82% vs. 87%, p = 0.52 Missed issues requiring overnight management: 90% pre vs. 60% post, p = 0.03 |
| Schouten 2015 | United States | Academic center (single hospital) | Retrospective chart review | Adult hospitalists | Shift | No intervention | Rapid response team call: 4/305 control vs. 5/500 intervention, p = 0.68 Code team calls: 0/305 control vs. 1/500 intervention, p = 0.43 Transfer to higher level of care: 2% control vs. 2% intervention, p = 0.93 30-day readmission: 16% control vs. 13% intervention, p = 0.23 Hospital LOS (median hours): 66.5 control vs. 70.3 intervention, p = 0.30 Adverse events: Temporary harm with intervention: 4 control vs. 7 intervention, p = 0.92 Adverse events: Temporary harm with prolonged hospitalization: 7 control vs. 8 intervention, p = 0.53 Adverse events: Permanent harm: 0 control vs. 1 intervention, p = 0.44 Adverse events: Intervention to sustain life: 0 control vs. 6 intervention, p = 0.14 Adverse events: Death: 0 control vs. 0 intervention, p = 1.00 Total adverse events per 100 admissions: 3.61 control vs. 4.40 intervention, p = .59% admissions with adverse event: 2.6% control vs. 3.2% intervention, p = 0.64 |
| Singh 2019 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents | Shift | Setting best practices/handoffs | Mean daily rate of nonlethal adverse events: 0.54 pre vs. 0.28 post, p = 0.10 |
| Skelton 2019 | United Kingdom | Teaching (multi-hospital) | Pre/post | Psychiatry trainees and general practice trainees | Weekend | Written reference materials, Prerecorded content | Adverse incidents: 21 pre vs. 12 post, p = 0.29 Whether handover improved patient care: 100%, no p-value reported Whether information during handover was inadequate before intervention: 96%, no p-value reported |
| Sonoda 2021 | United States | Academic center (single hospital) | Pre/post | Family Medicine residents | Shift | Didactic lecture content, small group learning | Unexpected floor calls: 54.4% pre vs. 36.2% post, p < 0.05 Overall medical errors: 6 pre vs. 10 post, no p-value reported |
| Starmer 2013 | United States | Academic center (single hospital) | Pre/post | Pediatrics residents | Shift | Setting best practices/guidelines, Within EMR electronic intervention, Outside of EMR electronic intervention, Standard scheduled face-to-face handoff, Didactic lecture content | Medical errors per 100 admissions: 33.8 pre vs. 18.3 post, p < 0.001 Preventable adverse events per 100 admissions: 3.3 pre vs. 1.5 post, p = 0.04 Nonintercepted potential adverse events: 7.3 pre vs. 3.3 post per 100 admissions (p = 0.002) Intercepted potential adverse event: 5.0 pre vs. 8.3 post per 100 admissions, p < 0.001 Errors with little or no potential for harm: 8.3 pre vs. 5.2 post per 100 admissions, p = 0.04 Nonpreventable adverse events: 1.7 pre vs. 1.6 post per 100 admissions, p = 0.91 Time spent with patients (percentage of time in 24 h period at bedside): 8.3 pre vs. 10.6 post, p = 0.03 Time spent at the computer: 24.2% pre vs. 23.2% post, p = 0.64 |
| Starmer 2014 | US and Canada | Academic center (multi-hospital) | Pre/post | Pediatrics residents | Shift | Within EMR electronic intervention, Role-playing/simulation, Prerecorded content, small group learning | Medical Errors and Adverse Events: 24.5 pre vs. 18.8 per 100 admissions post, p < 0.001 Preventable adverse events: 261 pre vs. 173 post, p < 0.001 Duration of oral handoffs (minutes per pt): 2.4 pre vs. 2.5 post, p = 0.55 Percent of time spent w pts/families: 11.8% pre vs. 12.5% post, p = 0.41 Time spent writing/editing handoffs (in 24 h): 0.6% and 1.3%, p = 0.54 |
| Tam 2018 | Canada | Academic center (single hospital) | Randomized trial | Internal Medicine residents | Shift | Standard scheduled face-to-face handoff, Didactic lecture content | All medical errors: RR 1.18 [0.49,2.28], p = 0.72 Proportion of patients transferred to ICU (RR): 1.20 [0.44,3.32], p = 0.72 Proportion of patients evaluated by critical care (RR): 0.89 [0.54,1.48], p = 0.66 In-hospital mortality rate (RR): 0.93 [0.63,1.39], p = 0.73 Preventable adverse events (RR): 0.52 [0.09,3.10], p = 0.47 Proportion of patients receiving resource utilization overnight (RR): 1.50 [1.12,2.00], p = 0.01 |
| Telem 2011 | United States | Academic center (single hospital) | Pre/post | Surgery residents | Shift | Teaching sessions, pre-recorded content, role-playing/simulation | Sentinel events - major morbidity/mortality errors: 1 overall, not significant Percentage of erroneous orders in order entry: 14.5 pre vs. 12.2 post, p = 0.003 |
| VanEaton 2010 | United States | Academic center, Community teaching (multi-hospital) | Randomized trial | Internal Medicine residents, Surgery residents | Shift | Within EMR electronic intervention | Medical errors per 1000 patient-days: 6.33 control vs. 5.61 intervention, p = 0.68 Adverse drug events (OR): 1.10 [0.69, 1.74], p = 0.70 Resident-reported events per team: 6.0 control vs. 6.6 intervention, p = 0.66 |
| Wohlauer 2012 | United States | Academic center (single hospital) | Pre/post | Internal Medicine residents, Surgery residents | Shift | Within EMR electronic intervention | Mean time pre-rounding (min): 62.7 pre vs. 51.9 post, p = 0.0064 Missed patients on rounds-less than once per month: 57% pre vs. 70% post, p = 0.0037 |
| Wolfe 2018 | United States | Academic center (single hospital) | Pre/post | Surgery faculty and residents | Shift | Standard scheduled face-to-face handoff | Length of stay: 6 days pre vs. 4.9 days post, p < 0.0001 Intensive care length of stay: 2.1 days pre vs. 1.5 post, p < 0.0001 Total vent days: 1.3 pre vs. 0.9 post, p = <0.0001 |
| Wolinska 2021 | Canada | Academic center | Pre/post | Pediatric surgeons | Shift | Didactic lecture content, Ongoing coaching | Length of handoff in minutes: 20 pre vs. 25 post, p < 0.01 |