Abstract
Standardization is one proposed solution for more efficient and effective nursing handoffs. The purpose of this review is to describe the format of handoff tools designed for standardizing nursing handoffs within inpatient acute care units. Four formats were identified in the 14 articles meeting inclusion criteria: printed templates, printed spreadsheets, mnemonics, and checklists. Little consistency across tools exists. Further research to compare efficiency and effectiveness of handoffs using different formats in needed.
Introduction
In 2006, the Joint Commission’s National Patient Safety Goals included the implementation of a standardized approach to handoff communication within a healthcare setting (i.e. standardized within unit, within hospital, etc.). Since then, nurses in hospitals across the United States have introduced a variety of tools to standardize patient handoffs during shift-to-shift reporting. Reviews of handoffs and tools for handoffs exist, no review of handoff tools for acute care (e.g. medical and/or surgical) nurses exists. Focus on acute care nursing handoffs is important because information needs are dependent on context, including characteristics of hospital, unit, discipline, and patient.
We define nursing handoff as a communication between two shifts of nurses occuring with the transfer of responsibility for a patient when information about patients and their care is exchanged. Nurses use the information exchanged to make appropriate clinical decisions and prioritize patient care during the upcoming shift. Handoffs also provide a venue for socialization, education, professional development, and emotional support.
Handoff tools have historically been informal and individualized. Standard forms for handoff tools have been suggested as a means to creating a more structured and efficient handoff, however a lack of accepted guidelines for handoffs or handoff tools exists. The purpose of this review is to describe the format of handoff tools designed for nursing handoffs within inpatient acute care units.
Methods
We completed a systematic literature search for nursing handoff tools using PubMed, CHINAHL, PsychInfo, and Scopus databases. Search terms included “handover,” “handoff,” “shift report,” and “intershift report.” Inclusion criteria were a focus on nursing handoffs in acute care settings with a description of a handoff tool, published in English between 1990 and 4 March 2011. “Tool” was defined as any memory aid or standardization method used during handoff. Letters, editorials, conference proceedings, and dissertations were excluded. Of the 625 citations yielded by the search, 14 articles met the full inclusion criteria after review.
Results
Four general types of handoff tools were described in the 14 articles: printed templates, printed spreadsheets, 3 different mnemonics, and checklists. All 14 tools used little or no integration with an electronic healthcare record (EHR). The tools based on mnemonics and checklists were the least complete, providing only categories of information to include in report. The templates and spreadsheets were more complete, providing areas to document specific observations and care performed during the shift. The templates consistently displayed static information such as demographics, diagnosis, and admission date at the top of the page. Other information was not organized reliably across the templates. The spreadsheets always displayed demographic data in the left-most column. Information regarding observations and care were displayed in the columns to the right, but a standard order was not noted across the different spreadsheets.
Conclusion
Published handoff tools for nursing handoffs in acute care units come in a variety of formats with differing levels of content specificity. Empirical studies to compare the efficiency and effectiveness of different formats are needed.