title: Decreasing handoff-related care failures in children's hospitals.
abstract: OBJECTIVE
  Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures.
  
  
  METHODS
  Twenty-three children's hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction.
  
  
  RESULTS
  Twenty-three children's hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]).
  
  
  CONCLUSIONS
  Implementation of a standardized evidence-based handoff process across 23 children's hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction.
authors.affiliation: Divisions of Critical Care Medicine, and mbigham@chmca.org.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Bigham
authors.affiliation: Children's Hospital Association, Overland Park, Kansas;
authors.forename: Tina R
authors.initials: TR
authors.lastname: Logsdon
authors.affiliation: Hospitalist Division, and.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Manicone
authors.affiliation: Department of Medicine, General Pediatrics, Children's Hospital Boston, Boston, Massachusetts;
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.affiliation: Departments of Critical Care Medicine, and.
authors.forename: Leslie W
authors.initials: LW
authors.lastname: Hayes
authors.affiliation: Performance Improvement, Children's of Alabama, Birmingham, Alabama;
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Randall
authors.affiliation: Emergency Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio;
authors.forename: Purva
authors.initials: P
authors.lastname: Grover
authors.affiliation: All Children's Hospital, Heart Center, St Petersburg, Florida;
authors.forename: Susan B
authors.initials: SB
authors.lastname: Collins
authors.affiliation: Department of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia;
authors.forename: Dana E
authors.initials: DE
authors.lastname: Ramirez
authors.affiliation: St Jude Children's Research Hospital, ICU, Memphis, Tennessee;
authors.forename: Crystal D
authors.initials: CD
authors.lastname: O'Guin
authors.affiliation: Patient Care Services, Children's National Medical Center, Washington, District of Columbia;
authors.forename: Catherine I
authors.initials: CI
authors.lastname: Williams
authors.affiliation: Children's Health Care of Atlanta, Atlanta, Georgia; and.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Warnick
authors.affiliation: Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, andDivision of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D017598:Efficiency, Organizational; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D061214:Patient Safety; D058996:Quality Improvement
keywords: care failure; handovers; patient safety; quality improvement; transition of care