Presentation
PS13 - The Evolution of Handoff Standardization in Healthcare: Past, Present, and Future
DescriptionSummary:
Introduction
Prior to 2006, the healthcare industry faced substantial challenges related to handoff communications, which included crucial moments where the care of a patient was transferred from one healthcare professional or team to another. Different facilities and even departments within the same hospital had varied methods of communication, leading to inconsistencies in care, medication errors, and omissions of vital patient information. In 2006 the Joint Commission, recognizing the implications of these issues, created a mandate that handoff processes must be standardized. This mandate was a call to the healthcare industry, stressing the importance of standardized handoff protocols to enhance patient safety during care transitions. Although altruistic in its attempts to improve safety, the mandate came with little guidance as to what exactly standardization means, how it’s implemented, and what benchmarks are indicative of good handoff standardization and practice.
In the wake of the Joint Commission's mandate, healthcare institutions embarked on a mission to identify and implement effective standardization protocols. Although there are notable protocols such as SBAR (situation, background, assessment, and recommendation) and IPASS (Illness severity, patient summary, action list, situation awareness, and synthesis), hundreds of protocols and mnemonics have been created across the healthcare industry in the past decade. Research studies conducted over the last decade provide compelling evidence of the efficacy of standardized handoff protocols. These positive effects include fewer adverse events, decreased miscommunication, and an overall increase in staff satisfaction. However, the fact that specific methods and approaches work better in certain clinical settings and that funding is integral to the success of handoff improvement programs, have led to heterogeneity across the field with interventions and metrics often being “homegrown” leading to inconsistency in findings and outcomes.
Given the issues, the future of handoff standardization is poised for exciting advancements. As the digital transformation of healthcare continues, electronic health records (EHRs) and specialized handoff software are expected to play a pivotal role. These tools can automate some aspects of the handoff process, ensuring that crucial patient data is not only consistently recorded but also easily accessible. The utilization of AI in handoffs is unknown and could profoundly impact the way this work occurs, with AI systems potentially providing distinct summaries of patient information that simply cannot occur in the current work system.
Method
Drawing on meta-analyses, systematic reviews, and empirical articles related to the use of some standardized handoff protocols, the primary aim of this lecture is to provide the audience with understanding of the steps that have been taken to improve handoffs in healthcare. This review will highlight the range of standardized protocols put into place since the 2006 Joint Commission mandate which requires all healthcare providers to "implement a standardized approach to handoff communications including an opportunity to ask and respond to questions" (2006 National Patient Safety Goal 2E). We will also dive into the issues and ambiguity of this requirement, as well as recommend future research and steps in the right direction. Overall, this review will present findings from peer-reviewed literature to shed light on the need for better practices to improve handoffs in healthcare while providing recommendations on how to do so.
Main Findings
The importance of effective handoff communication cannot be overstated given the vast and diverse landscape of healthcare. Over the past two decades, there's been significant movement towards improving this critical juncture in patient care, driven by mounting research and the Joint Commission's 2006 mandate. As listed below, the primary findings highlight that (1) standardization is not a one size fits all solution, (2) protocols and handoff training bundles appear to help, but the measurement of outcomes are poor and heterogeneous thus far, (3) specified toolkits, such as IPASS, have risen in popularity and utilization, yet have questionable reliability and efficacy, (4) handoffs are still thought of as a provider problem, but it is arguably more of an organizational problem, (5) there is ample evidence that the effectiveness of handoff interventions is based on whether there was funding or not behind the intervention, and (6) the future of handoffs will need to include iterative design changes, taking into account evolutionary perspectives on handoffs and their associated checklists/protocols needing to be adaptive to a multitude of scenarios and use cases across time.
1. Standardization is not a one size fits all solution - different types of handoffs, including shift change and perioperative handoffs, may require different solutions, training, and tools. Different hospitals and medical centers may have to deal with variance in state laws, reporting of patient information, and various EMR systems that can fundamentally change the way the work is carried out.
2. Protocols and handoff training bundles appear to help improve outcomes based on meta-analytic evidence, but measurement of outcomes is poor and heterogeneous. Inconsistency in measurement is consistent - metrics, interventions, training are all heterogeneous and this leads to difficulty in understanding what does and does not work.
3. Specific toolkits and training systems such as IPASS have become widespread in popularity and utilization, but have questionable reliability and efficacy. Hundreds of handoff protocols, checklists, and bundles have sprung into existence in the past decade and very little work has looked at their differences or compared them to see what works best in a given context (Lazzara, E. H., Riss, R., Patzer, B., Smith, D. C., Chan, Y. R., Keebler, J. R., ... & Palmer, E. M. (2016). Directly comparing handoff protocols for pediatric hospitalists. Hospital pediatrics, 6(12), 722-729.)
4. Handoffs are still thought of as a provider problem, but are arguably an organizational problem. This mindset is dangerous and pervasive and goes against the ethos of HF/E (Keebler, J. R., Lazzara, E., Griggs, A., Tannenbaum, S., Fernandez, R., Greilich, P., & Salas, E. (2022). Holistic strategy for promoting effective handoffs. BMJ leader, leader-2022.)
5. There's evidence that the effectiveness and quality of handoff interventions is based on whether there was funding or not behind the intervention (Mardis, M., Davis, J., Benningfield, B., Elliott, C., Youngstrom, M., Nelson, B., ... & Riesenberg, L. A. (2017). Shift-to-shift handoff effects on patient safety and outcomes: a systematic review. American Journal of Medical Quality, 32(1), 34-42.). This creates a fundamental issue that the work is better/safer when there's money, and worse off when there's not. How do we best standardize in light of limited funds for many hospitals and medical centers? How do providers make a good argument for their C-suite to fund handoff initiatives?
6. The future of handoffs will need to include iterative design changes - taking an evolutionary perspective on handoffs and their associated checklists/protocols being something that must adapt and change across time. How will AI influence this? How can we best adjust needs in real time? How do we leverage information from EMRs to improve workflow?
Reflecting on our journey, it's evident that the realm of handoff communication in healthcare has seen significant transformation. The milestones achieved since the Joint Commission's directive are commendable. However, this journey, while marked by progress, is far from its conclusion. With healthcare's ever-evolving nature, as new treatments emerge and technologies advance, the quest for perfecting handoff communication remains both challenging and essential. Our ongoing commitment to refining these processes, even as we laud the progress achieved, exemplifies the relentless pursuit of excellence and patient safety at the heart of modern healthcare.
Introduction
Prior to 2006, the healthcare industry faced substantial challenges related to handoff communications, which included crucial moments where the care of a patient was transferred from one healthcare professional or team to another. Different facilities and even departments within the same hospital had varied methods of communication, leading to inconsistencies in care, medication errors, and omissions of vital patient information. In 2006 the Joint Commission, recognizing the implications of these issues, created a mandate that handoff processes must be standardized. This mandate was a call to the healthcare industry, stressing the importance of standardized handoff protocols to enhance patient safety during care transitions. Although altruistic in its attempts to improve safety, the mandate came with little guidance as to what exactly standardization means, how it’s implemented, and what benchmarks are indicative of good handoff standardization and practice.
In the wake of the Joint Commission's mandate, healthcare institutions embarked on a mission to identify and implement effective standardization protocols. Although there are notable protocols such as SBAR (situation, background, assessment, and recommendation) and IPASS (Illness severity, patient summary, action list, situation awareness, and synthesis), hundreds of protocols and mnemonics have been created across the healthcare industry in the past decade. Research studies conducted over the last decade provide compelling evidence of the efficacy of standardized handoff protocols. These positive effects include fewer adverse events, decreased miscommunication, and an overall increase in staff satisfaction. However, the fact that specific methods and approaches work better in certain clinical settings and that funding is integral to the success of handoff improvement programs, have led to heterogeneity across the field with interventions and metrics often being “homegrown” leading to inconsistency in findings and outcomes.
Given the issues, the future of handoff standardization is poised for exciting advancements. As the digital transformation of healthcare continues, electronic health records (EHRs) and specialized handoff software are expected to play a pivotal role. These tools can automate some aspects of the handoff process, ensuring that crucial patient data is not only consistently recorded but also easily accessible. The utilization of AI in handoffs is unknown and could profoundly impact the way this work occurs, with AI systems potentially providing distinct summaries of patient information that simply cannot occur in the current work system.
Method
Drawing on meta-analyses, systematic reviews, and empirical articles related to the use of some standardized handoff protocols, the primary aim of this lecture is to provide the audience with understanding of the steps that have been taken to improve handoffs in healthcare. This review will highlight the range of standardized protocols put into place since the 2006 Joint Commission mandate which requires all healthcare providers to "implement a standardized approach to handoff communications including an opportunity to ask and respond to questions" (2006 National Patient Safety Goal 2E). We will also dive into the issues and ambiguity of this requirement, as well as recommend future research and steps in the right direction. Overall, this review will present findings from peer-reviewed literature to shed light on the need for better practices to improve handoffs in healthcare while providing recommendations on how to do so.
Main Findings
The importance of effective handoff communication cannot be overstated given the vast and diverse landscape of healthcare. Over the past two decades, there's been significant movement towards improving this critical juncture in patient care, driven by mounting research and the Joint Commission's 2006 mandate. As listed below, the primary findings highlight that (1) standardization is not a one size fits all solution, (2) protocols and handoff training bundles appear to help, but the measurement of outcomes are poor and heterogeneous thus far, (3) specified toolkits, such as IPASS, have risen in popularity and utilization, yet have questionable reliability and efficacy, (4) handoffs are still thought of as a provider problem, but it is arguably more of an organizational problem, (5) there is ample evidence that the effectiveness of handoff interventions is based on whether there was funding or not behind the intervention, and (6) the future of handoffs will need to include iterative design changes, taking into account evolutionary perspectives on handoffs and their associated checklists/protocols needing to be adaptive to a multitude of scenarios and use cases across time.
1. Standardization is not a one size fits all solution - different types of handoffs, including shift change and perioperative handoffs, may require different solutions, training, and tools. Different hospitals and medical centers may have to deal with variance in state laws, reporting of patient information, and various EMR systems that can fundamentally change the way the work is carried out.
2. Protocols and handoff training bundles appear to help improve outcomes based on meta-analytic evidence, but measurement of outcomes is poor and heterogeneous. Inconsistency in measurement is consistent - metrics, interventions, training are all heterogeneous and this leads to difficulty in understanding what does and does not work.
3. Specific toolkits and training systems such as IPASS have become widespread in popularity and utilization, but have questionable reliability and efficacy. Hundreds of handoff protocols, checklists, and bundles have sprung into existence in the past decade and very little work has looked at their differences or compared them to see what works best in a given context (Lazzara, E. H., Riss, R., Patzer, B., Smith, D. C., Chan, Y. R., Keebler, J. R., ... & Palmer, E. M. (2016). Directly comparing handoff protocols for pediatric hospitalists. Hospital pediatrics, 6(12), 722-729.)
4. Handoffs are still thought of as a provider problem, but are arguably an organizational problem. This mindset is dangerous and pervasive and goes against the ethos of HF/E (Keebler, J. R., Lazzara, E., Griggs, A., Tannenbaum, S., Fernandez, R., Greilich, P., & Salas, E. (2022). Holistic strategy for promoting effective handoffs. BMJ leader, leader-2022.)
5. There's evidence that the effectiveness and quality of handoff interventions is based on whether there was funding or not behind the intervention (Mardis, M., Davis, J., Benningfield, B., Elliott, C., Youngstrom, M., Nelson, B., ... & Riesenberg, L. A. (2017). Shift-to-shift handoff effects on patient safety and outcomes: a systematic review. American Journal of Medical Quality, 32(1), 34-42.). This creates a fundamental issue that the work is better/safer when there's money, and worse off when there's not. How do we best standardize in light of limited funds for many hospitals and medical centers? How do providers make a good argument for their C-suite to fund handoff initiatives?
6. The future of handoffs will need to include iterative design changes - taking an evolutionary perspective on handoffs and their associated checklists/protocols being something that must adapt and change across time. How will AI influence this? How can we best adjust needs in real time? How do we leverage information from EMRs to improve workflow?
Reflecting on our journey, it's evident that the realm of handoff communication in healthcare has seen significant transformation. The milestones achieved since the Joint Commission's directive are commendable. However, this journey, while marked by progress, is far from its conclusion. With healthcare's ever-evolving nature, as new treatments emerge and technologies advance, the quest for perfecting handoff communication remains both challenging and essential. Our ongoing commitment to refining these processes, even as we laud the progress achieved, exemplifies the relentless pursuit of excellence and patient safety at the heart of modern healthcare.
Event Type
Poster Presentation
TimeMonday, March 254:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives