of information for bedside handoffs or when
a computerized handoff system was introduced
because the interventions reduced the time needed
to prepare and process the handoff.20,30 Lastly,
healthcare providers’ learning was enhanced when
a structured process was used for bedside handoffs.41
However, the intervention reduced socializing
between the handoff participants which was
also noted when using voicemail handoffs.6,20
Patient outcomes
Some studies reported benefits by way of
improved patient outcomes from improvements
in handoffs. Patient satisfaction was commonly
reported following a bedside handoff.17,18 By using
this intervention, patient involvement in care and
patient-healthcare provider contact were also
promoted.20,41 Moreover, patients discussed
previously were more likely to be re-discussed
by healthcare providers at consecutive handoffs
when information tools were used to support a
verbal handoff.5 A randomized-controlled study
showed that the use of a computerized handoff
system reduced the number of patients missed on
healthcare providers’ rounds by half.30 In addition,
patients’ length of stay was reduced by using an
electronic handoff template to structure handoff
information.25 The authors claimed that this
happened because the intervention was efficient
for transfer patient details, thus bringing about
better quality of care. Similarly, a study found
a reduction in the cost of patient care from
supplementing a written report with a telephone
conversation.19
Discussion and recommendations
Clinical handoff is a tool for healthcare
providers which can lead to positive patient outcomes.
Since handoff breakdown has been widely
experienced, a number of interventions aimed at
improving handoff have been attempted. However,
the impacts of these interventions were assessed
for different targets. Some seemed to benefit
patients. However, those outcomes were indirectly
measured through the healthcare providers’ perceptions
which were vulnerable to subjective bias.
Some enhanced system functions which resulted
in more efficient work and some improved quality
of the information transferred, but the effects of
these interventions on patient outcomes could not
be substantiated. The lack of valid measurements
of patient outcomes and ethical considerations
relating to patient harm could make it difficult and
complex to evaluate the impacts of interventions
directly on patient outcomes. There is, therefore,
little empirical evidence in the literature as to
how interventions were able to bring about better
patient outcomes. Of the studies reviewed, only
a few studies directly evaluated patient outcomes.
In selecting interventions aimed at improving
handoffs, organizations should consider which
method is most appropriate to their setting, depending
on the expected outcomes and available
resources. The applicability of the interventions
selected should be carefully and thoroughly
considered prior to implementation. Table 1 also
summarizes the strengths and weaknesses of the
interventions described in the studies reviewed,
together with recommendations for implementing