Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods.
BACKGROUND
Handover of patient information represents a critical time period during a patient's hospitalisation. While recent guidelines promote standardised communication during these patient care transitions, significant variability in structure and practice persists among hospitals and providers.


METHODS
The authors surveyed internal medicine residents regarding handover practices before and after introduction of a structured, web-based handover application. The handover application standardised patient data in a format suitable for both patient handovers and day-to-day patient management.


RESULTS
A total of 80 residents were surveyed prior to the intervention (80% response rate) and 161 residents during the intervention (average 68% response rate for all surveys distributed). At baseline, residents perceived deficits in handover practices related to the variability of information transferred and correlated that variability to near-miss events. After introduction of the handover application, 100% of handovers contained an updated problem list, active medications, and code status (compared to <55% at baseline, p<0.01); residents perceived approximately half as many near-miss events on call (31.5% vs 55%; p=0.0341) and were twice as likely to respond that they were confident or very confident in their patient handovers compared to traditional practices (93% vs 49%; p=0.01).


CONCLUSIONS
Standardisation of information transmitted during patient handovers through the use of a structured, web-based application led to consistent transfer of vital patient information and was associated with improved resident confidence and fewer perceived near-miss events on call.
Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA. cbpayne@emory.edu
Christina E
CE
Payne
Jason M
JM
Stein
Traci
T
Leong
Daniel D
DD
Dressler
D001291:Attitude of Health Personnel; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010347:Patient Care Planning / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D062209:Patient Handoff / Q000592:standards*; D010360:Patient Transfer / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*