Between Department
Handoff Reporting
Briana Walters, Madison Totty, Sydney Mingo, Blake George, and Jacques Ravary
NUR 270: Professional Nursing Concepts II
Centra College Associate Degree in Nursing Program
Date: 04/13/2023
Background
● Purpose: To reduce the incident of medical errors related to inadequate
communication between staff members that affect quality care.
● Need: To promote collaborative communication to decrease medical errors
and to promote positive collaboration between departments or professional
personnel.
● Overview: The process of communication between health care
professionals, and the potential errors that could occur during the
communication process.
Problem Statement: PICOT
● In a hospital setting, how efficient is nurse to nurse handoff at preventing
medical errors?
Search Keywords
Ebsco Host
● Key words: Nursing, Handoff, and Safety
● 240 Results
● Revised search: SBAR, interprofessional communication, acute care, and
adverse event
● 13 hits
Relationship between Interprofessional
Communication and Team Task Performance
● Population: 194 nursing students, divided into 49 teams.
● Intervention: SBAR communication tool
● Strengths: Included a doctor in study, uses an emergency setting, level
three cohort study
● Weaknesses: smaller study, limited studies into how SBAR contributes to
healthcare emergency.
● Application: The team task performance without error correlated
positively with read back communication.
Impact of the communication and patient hand-off tool
SBAR on patient safety: a systematic review
● Population: doctors and nurses working in the healthcare field (Systematic
Review)
● Intervention: educational programs, Organizational/human support and
interactive teaching
● Strength: discusses the effects of correctly communicated SBAR on
improving patient outcomes
● Weaknesses: Limited availability of data with regards to all studies
individually
● Application: evaluates how the implementation of SBAR in clinical
settings improves patient outcomes
Improving Patient Care Through Handoff Communication
● Population: Patients receiving care from transitional settings
● Intervention: Using information from the scheduling EHR, a generated
report will be sent to receiving staff
● Strengths: SBAR format reporting to the receiving nurse outside of the
home location
● Weakness: electronic failure when the template or scheduling EHR fails
● Application: SBAR format of handoffs specifically for transitional care
settings
Factors affecting nursing error communication in intensive care units: A qualitative study
● Population: 17 nurses from 2 separate medical/Surgical hospitals in Iran
● Intervention: All nurses performed a structured interview by a third party. The data
was collected and coded into subcategories and a third party analyzed the results..
● Strengths: Demonstrates the consequences of patient to nurse, nurse to nurse, and
nursing errors through communication, both nurses and facilities were interviewed
to reduce effects of bias
● Weakness: Possibility of avoidance in sharing their personal error-related
experiences, and a small sample size
● Application: The culture of error communication and the consequences of error
communication in the ICU through a third party interview
Evaluation of the Impact of Handoff Based on the SBAR
Technique on Quality of Nursing Care
● Population: all patients hospitalized in the coronary care units of two
public hospitals in Bojnurd, Iran
● Interventions: Nurses were educated on SBAR technique as opposed to
previous written and oral bedside report
● Strengths: The SBAR handoff technique leads to a significant increase in
quality of patient care
● Weaknesses: Patients differed before and after the intervention, which can
lead to different perceptions of the quality of care
● Application: Implementation of education on SBAR handoff reporting to
improve quality of care
Preoperative Checklist, Handoff Communication
● Official preoperative checklist for operative
procedures for outpatients, same day admission
patients, and inpatients
● Used as preoperative checklist pass
● Completed before patients enter the operating room
● Serves as criteria and guidelines for pre-operative
handoff communication between nurses.
● Having guidelines for handoff report will result in
fewer adverse events.
Evidence-Based Policy: Communication Handoffs
Overview
● Number 1 cause of anesthesia-related sentinel events is breakdown of communication.
● Failure in communication is the second most common contributing to adverse events in recovery
units
● A complete omission of information occurs in 57% of surgical malpractice claims.
● A physical handoff checklist decreased handover related failures by 69% in a year.
● I-PASS handover bundle led to a 23% reduction in overall medical errors and 30% reduction in
preventable adverse events.
● Handoff reports serve as a guideline for standardized information transfer as well as a physical
checklist of vital information.
Evidence-Based Policy: Communication Handoffs Continued
Relevance with department handoff reports
● Three challenges that affect collaborative communication and increase medical errors: distractions, lack
of standardization and personnel dynamics.
● Distractions can be overcome by moving to an area that limits a noisy and chaotic environment with the
absence of visual and auditory distractions, and promotes a direct, focused, and stimulus free
environment.
● Urgent tasks should be completed before the beginning of handoffs, encourage direct communication
between care members, closed-loop communication, all relevant team members are present, and the use
of a checklist or cognitive aid during handoff.
● A professional dynamic should be utilized over a personnel dynamic. Standardized reports such as
SBAR will reduce sharing personnel dynamics and shift the information in a professional dynamic.
● Reducing the friction of authority gradient can reduce the unfamiliarity and opportunities where one is
reluctant to speak up.
Resources
- Abbaszade, A., Assarroudi, A., Armat, M. R., Stewart, J. J., Rakhshani, M. H., Sefidi, N., & Sahebkar, M. (2020). Evaluation of the impact of handoff based on the
SBAR technique on quality of nursing care. Journal of Nursing Care Quality, 36(3). https://doi.org/10.1097/ncq.0000000000000498
- Ghezeljeh, T. N., Farahani, M. A., & Ladani, F. K. (2020). Factors affecting nursing error communication in Intensive Care Units: A qualitative study. Nursing
Ethics, 28(1), 131–144. https://doi.org/10.1177/0969733020952100
- Methangkool, E., Tollinche, L., Sparling, J., & Agarwala, A. V. (2019). Communication: Is there a standard handover technique to transfer patient care? International
Anesthesiology Clinics, 57(3), 35–47. https://doi.org/10.1097/aia.0000000000000241
- Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety:
A systematic review. BMJ Open, 8(8). https://doi.org/10.1136/bmjopen-2018-022202
- Lee, K.R., & Kim, E.J. ( 2020). Relationship between interprofessional communication and team task performance. Clinical Simulation in Nursing, 43, pg 44-50.
- Lucas, J., Shepherd, C., Best, C., Rodgers, G., Page, K., & Kyei, M. (2022). IMPROVING PATIENT CARE THROUGH HANDOFF COMMUNICATION..47th
Annual Oncology Nursing Society Congress, April 27-May 1, 2022, Anaheim, CA. Oncology Nursing Forum, 49(2), E123. https://doi.org/10.1188/22.ONF.E2
- Wilson, B., Deal, J., Mclean, V., Morcom, D. (2021). Preoperative Checklist, Handoff Communication. [CLIN.02.05.16] Centrahealth.
