title: Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review.
abstract: BACKGROUND
  Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care.
  
  
  OBJECTIVE
  This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs.
  
  
  METHODS
  We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures.
  
  
  RESULTS
  Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements.
  
  
  CONCLUSIONS
  The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.
authors.forename: Joshua
authors.initials: J
authors.lastname: Davis
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Riesenberg
authors.forename: Matthew
authors.initials: M
authors.lastname: Mardis
authors.forename: John
authors.initials: J
authors.lastname: Donnelly
authors.forename: Branden
authors.initials: B
authors.lastname: Benningfield
authors.forename: Mallory
authors.initials: M
authors.lastname: Youngstrom
authors.forename: Imelda
authors.initials: I
authors.lastname: Vetter
mesh_terms: D003142:Communication; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration* / Q000592:standards; D017063:Outcome Assessment, Health Care; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement; D014481:United States