Clinical handover and handoff in healthcare: a systematic review of systematic reviews

Abstract

Purpose The purpose of this systematic review is to appraise and summarize existing literature on clinical handover. Data sources We searched EMBASE, MEDLINE, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews. Study selection Included articles were reviewed independently by the review team. Data extraction The review team extracted data under the following headers: author(s), year of publication, journal, scope, search strategy, number of studies included, type of studies included, study quality assessment, used definition of handover, healthcare setting, outcomes measured, findings and finally some comments or remarks. Results of data synthesis First, research indicates that poor handover is associated with multiple potential hazards such as lack of availability of required equipment for patients, information omissions, diagnosis errors, treatment errors, disposition errors and treatment delays. Second, our systematic review indicates that no single tool arises as best for any particular specialty or use to evaluate the handover process. Third, there is little evidence delineating what constitutes best handoff practices. Most efforts facilitated the coordination of care and communication between healthcare professionals using electronic tools or a standardized form. Fourth, our review indicates that the principal teaching methods are role-playing and simulation, which may result in better knowledge transfer to the work environment, better health and patients’ well-being. Conclusions This review emphasizes the importance of staff education (including simulation-based and team training), non-technical skills and the implementation process of clinical handover in healthcare settings.

Effective nurse handoffs

“…1 Ideally, the standardized handoff process is incorporated into the workflow of the electronic health record to guide the verbal exchange and eliminate wasting time by taking notes. 2 Standardized training on how to conduct a handoff from the role of a sender and a receiver has been identified as key to success. 1 Champions and coaches are suggested to serve as role models to promote the process.…”

“…Desmedt et al2 conducted a review of systematic reviews and found some evidence that standardized and written handoffs resulted in improved teamwork, greater accuracy and consistency of information transfer, a decrease in the number of forgotten tasks, improved patient and provider satisfaction, and saved nursing time.They caution that good-quality research on handoff designs and their outcomes is limited and better-designed studies are required. A quality improvement approach is recommended to implement and sustain a highly reliable and high-quality handoff process 1…”

“…It should specify that a handoff is conducted face-to-face and include written and verbal components 1. Ideally, the standardized handoff process is incorporated into the workflow of the electronic health record to guide the verbal exchange and eliminate wasting time by taking notes 2…”

“…1 Numerous barriers interfere with effective handoffs, including inadequate nurse education on effective handoffs, increased workload and time pressure among nurses, poor motivation among nurses who feel unappreciated, lack of a policy and standardized process, and the lack of leadership's commitment to successful handoff implementation. 1,2 Too much unit noise, reduced privacy, and frequent interruptions are also known to negatively impact handoffs. 3 Successful nurse handoffs require the right preconditions, tools, and patient information delivered in the appropriate place using effective communication processes.…”

Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery

“…Any concerns for postoperative complications, including the potential risk of haematoma, are highlighted during the sign out, and should be cascaded through explicit handovers which must take place when transferring to the PACU and thereafter the ward. This should include communication of postoperative risks and specific concerns of bleeding [ 78 , 79 ] (Grade C). Direct surgical handover of any concerns to PACU and/or ward nurses can enhance staff awareness and improve patient safety.…”