title: A systematic review of the literature on the evaluation of handoff tools: implications for research and practice.
abstract: OBJECTIVE
  Given the complexities of the healthcare environment, efforts to develop standardized handoff practices have led to widely varying manifestations of handoff tools. A systematic review of the literature on handoff evaluation studies was performed to investigate the nature, methodological, and theoretical foundations underlying the evaluation of handoff tools and their adequacy and appropriateness in achieving standardization goals.
  
  
  METHODS
  We searched multiple databases for articles evaluating handoff tools published between 1 February 1983 and 15 June 2012. The selected articles were categorized along the following dimensions: handoff tool characteristics, standardization initiatives, methodological framework, and theoretical perspectives underlying the evaluation.
  
  
  RESULTS
  Thirty-six articles met our inclusion criteria. Handoff evaluations were conducted primarily on electronic tools (64%), with a more recent focus on electronic medical record-integrated tools (36% since 2008). Most evaluations centered on intra-departmental tools (95%). Evaluation studies were quasi-experimental (42%) or observational (50%), with a major focus on handoff-related outcome measures (94%) using predominantly survey-based tools (70%) with user satisfaction metrics (53%). Most of the studies (81%) based their evaluation on aspects of standardization that included continuity of care and patient safety.
  
  
  CONCLUSIONS
  The nature, methodological, and theoretical foundations of handoff tool evaluations varied significantly in terms of their quality and rigor, thereby limiting their ability to inform strategic standardization initiatives. Future research should utilize rigorous, multi-method qualitative and quantitative approaches that capture the contextual nuances of handoffs, and evaluate their effect on patient-related outcomes.
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Abraham
authors.forename: Thomas
authors.initials: T
authors.lastname: Kannampallil
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
mesh_terms: D005069:Evaluation Studies as Topic; D006801:Humans; D062209:Patient Handoff / Q000458:organization & administration*; D012107:Research Design
keywords: Care Continuity; Evaluation Method; Handoff Tools; Patient Safety; Standardization