title: Variation in printed handoff documents: Results and recommendations from a multicenter needs assessment.
abstract: BACKGROUND
  Handoffs of patient care are a leading root cause of medical errors. Standardized techniques exist to minimize miscommunications during verbal handoffs, but studies to guide standardization of printed handoff documents are lacking.
  
  
  OBJECTIVE
  To determine whether variability exists in the content of printed handoff documents and to identify key data elements that should be uniformly included in these documents.
  
  
  METHODS
  Pediatric hospitalist services at 9 institutions in the United States and Canada.
  
  
  METHODS
  Sample handoff documents from each institution were reviewed, and structured group interviews were conducted to understand each institution's priorities for written handoffs. An expert panel reviewed all handoff documents and structured group-interview findings, and subsequently made consensus-based recommendations for data elements that were either essential or recommended, including best overall printed handoff practices.
  
  
  RESULTS
  Nine sites completed structured group interviews and submitted data. We identified substantial variation in both the structure and content of printed handoff documents. Only 4 of 23 possible data elements (17%) were uniformly present in all sites' handoff documents. The expert panel recommended the following as essential for all printed handoffs: assessment of illness severity, patient summary, action items, situation awareness and contingency plans, allergies, medications, age, weight, date of admission, and patient and hospital service identifiers. Code status and several other elements were also recommended.
  
  
  CONCLUSIONS
  Wide variation exists in the content of printed handoff documents. Standardizing printed handoff documents has the potential to decrease omissions of key data during patient care transitions, which may decrease the risk of downstream medical errors.
authors.affiliation: Divisions of Pediatric Hospital Medicine and Medical Education, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
authors.forename: Glenn
authors.initials: G
authors.lastname: Rosenbluth
authors.affiliation: Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, Utah.|Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: James F
authors.initials: JF
authors.lastname: Bale
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Starmer
authors.affiliation: Section of General Pediatrics, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Spector
authors.affiliation: Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, Utah.|Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Divisions of Medical Education and Pediatric Hematology/Oncology, University of California San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: West
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Sectish
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.|Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
mesh_terms: D002170:Canada; D002648:Child; D003142:Communication; D005260:Female; D006287:Health Planning Guidelines; D020445:Hospitalists / Q000592:standards*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D020380:Needs Assessment / Q000592:standards*; D062209:Patient Handoff / Q000592:standards*; D014481:United States