A model for building a standardized hand-off protocol.
BACKGROUND
The Joint Commission has made a "standardized approach to hand-off communications" a National Patient Safety Goal.


METHODS
An interactive 90-minute workshop (hand-off clinic) was developed in 2005 to (1) develop a standardized process for the handoff, (2) create a checklist of critical patient content, and (3) plan for dissemination and training.


CONCLUSIONS
To date, 7 of 10 residency programs have participated. Analysis of these protocols demonstrated that the hand-off process is highly variable and discipline-specific. Although all disciplines required a verbal handoff, because of competing demands, verbal communication did not always occur. In some cases, the transfer of professional responsibility was separated in time and space from the transfer of information. For example, in two cases, patient tasks were assigned to other team members to facilitate timely departure of a postcall resident (to meet resident duty-hour restrictions), but results were not formally communicated to anyone. The hand-off clinic facilitated the incorporation of "closed-loop" communication by requiring that follow-up on these tasks be conveyed to the on-call resident.


CONCLUSIONS
This model for design and implementation can be applied to other health care settings.
Arora
Vineet
V
Department of Medicine, University of Chicago, USA. varora@medicine.bsd.uchicago.edu
Johnson
Julie
J
D000465:Algorithms; D002641:Chicago; D002985:Clinical Protocols; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration; D003663:Decision Trees; D004502:Education, Medical, Continuing; D006801:Humans; D007318:Inservice Training; D007400:Interprofessional Relations; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008505:Medical Staff, Hospital / Q000193:education / Q000458:organization & administration* / Q000523:psychology; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D014481:United States