Hospitalist handoffs: a systematic review and task force recommendations.
BACKGROUND
Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety.


OBJECTIVE
To develop recommendations for hospitalist handoffs during shift change and service change.


METHODS
PubMed (through January 2007), Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network, white papers, and hand search of article bibliographies.


METHODS
Controlled studies evaluating interventions to improve in-hospital handoffs (n = 10).


METHODS
Studies were abstracted for design, setting, target, outcomes (including patient-level, staff-level, or system-level outcomes), and relevance to hospitalists.


RESULTS
Although there were no studies of hospitalist handoffs, the existing literature from related disciplines and expert opinion support the use of a verbal handoff supplemented with written documentation in a structured format or technology solution. Technology solutions were associated with a reduction in preventable adverse events, improved satisfaction with handoff quality, and improved provider identification. Nursing studies demonstrate that supplementing verbal exchange with a written medium leads to improved retention of information. White papers characterized effective verbal exchange, as focusing on ill patients and actions required, with time for questions and minimal interruptions. In addition, content should be updated daily to ensure communication of the latest clinical information. Using this literature, recommendations for hospitalist handoffs are presented with corresponding levels of evidence. Recommendations were reviewed by hospitalists at the Society of Hospital Medicine (SHM) Annual Meeting and by an interdisciplinary team of expert consultants and were endorsed by the SHM governing board.


CONCLUSIONS
The systematic review and resulting recommendations provide hospitalists a starting point from which to improve in-hospital handoffs.
Arora
Vineet M
VM
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA. varora@medicine.bsd.uchicago.edu
Manjarrez
Efren
E
Dressler
Daniel D
DD
Basaviah
Preetha
P
Halasyamani
Lakshmi
L
Kripalani
Sunil
S
D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000592:standards*; D020445:Hospitalists; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000458:organization & administration; D011787:Quality of Health Care