A Model for Building a Standardized
Hand-off Protocol
National Patient Safety Goals
Background: The Joint Commission has made a
“standardized approach to hand-off communications” a
National Patient Safety Goal.
Method: An interactive 90-minute workshop (handoff
clinic) was developed in 2005 to (1) develop a standardized
process for the handoff, (2) create a checklist
of critical patient content, and (3) plan for dissemination
and training.
Conclusion: To date, 7 of 10 residency programs have
participated. Analysis of these protocols demonstrated
that the hand-off process is highly variable and disciplinespecific.
Although all disciplines required a verbal
handoff, because of competing demands, verbal communication
did not always occur. In some cases, the transfer
of professional responsibility was separated in time and
space from the transfer of information. For example, in
two cases, patient tasks were assigned to other team
members to facilitate timely departure of a postcall resident
(to meet resident duty-hour restrictions), but results
were not formally communicated to anyone. The handoff
clinic facilitated the incorporation of “closed-loop”
communication by requiring that follow-up on these
tasks be conveyed to the on-call resident.
Discussion: This model for design and implementation
can be applied to other health care settings