Such a process is intended to provide a link in
changes in actions and behaviors, particularly
within complex social and political settings.
Although improvements in handoffs were
achieved by specific interventions in many studies,
some studies applied a combination of different
handoff methods. For example, Wilson41 employed
bedside handoffs using a structured process.
Berkenstadt et al.37 introduced a handoff checklist/protocol
and simulation-based handoff training.
Clark et al.42 applied an electronic handoff
template and a handoff protocol. Gakhar and
Spencer32 implemented a structured sign-out
curriculum and an electronic sign-out system.
Table 1 presents a summary of handoff improvement
interventions utilized in the studies reviewed.
The outcomes of the interventions studied were
assessed and are presented in the following
section.
Outcomes of handoff improvement interventions
Analysis of the studies reviewed yielded
the following targeted outcomes aimed at by
different handoff improvement interventions:
system outcomes; information outcomes; outcomes
relating to healthcare providers; and patient outcomes.
System outcomes
Many studies found improvements in
system functions resulting from the interventions
employed. Commonly, the time taken for handoff
was shortened by the employment of a bedside
handoff within a structured process,17,18,41 a handoff
protocol,28 or a computerized handoff system.30
In particular, a computerized handoff system was
able to shorten the handoff process by reducing
the time healthcare providers spent hand-copying
patients’ basic data.30 Furthermore, teamwork and
the safety climate was significantly improved
through the use of handoff education.9 Especially,
technical errors were reduced and less teamwork
was required when using the handoff protocol
developed based on Formula 1 pit-stop and
aviation models for patients transfer from surgery
to ICU.28 Studies among physicians found the
reduction of the frequency of inappropriate tasks
left by outgoing healthcare providers when a
standardized handoff form was used.2,22 If
performed electronically, this intervention was
able to improve clarity as to the time of transfer
of care by letting the other healthcare providers
know when responsibility was transferred via a
computer screen.2
Improvement in documentation was observed
when staff used written records or a computerized
handoff system as a source of information in the
lead-up to handoff.20,32 Moreover, the convenience
of conveying and accessing information was
facilitated through using voicemail handoff.6
Although a study implementing a new computerized
handoff system did not detect any effect
on the number of medical errors, adverse drug
events (ADEs) and reported incidents, it did
indicate that the intervention did not make the
handoff process worse.31