A before-and-after study of improved handoff techniques showed an association between improved handoffs and improved patient care at a major teaching hospital. Rates of medical errors and preventable adverse events fell after a standardized resident handoff bundle was implemented in two pediatric wards. Residents and interns spent significantly more time with patients after the handoff bundle was implemented but did not spend more time on handoff procedures, according to a study published Dec. 3 in the Journal of the American Medical Association. 

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Researchers compared rates of medical errors and preventable adverse events before and after the introduction of a standardized bundle of handoff procedures in two pediatric wards. The bundle included training on TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) developed by the Agency for Healthcare Quality and Research and the Department of Defense, mnemonics to standardize verbal handoffs, restructuring of verbal handoffs, relocation of handoffs to a quiet and private space, and periodic handoff oversight by a chief resident or attending physician.

The study involved 642 patients and 42 residents before introduction of the handoff bundle and 613 patients and 42 residents after the handoff bundle. Results showed medical errors decreased from 33.8 per 100 admissions to 18.3 per 100 admissions (p<0.001) following introduction of the handoff bundle. Preventable adverse events fell from 3.3 per 100 admissions to 1.5 per 100 admissions (p=0.04). There was no significant change in nonpreventable errors –11 pre-intervention and 10 post-intervention.

"We found that error rates, care processes, and work flow were improved following introduction of the resident handoff bundle," wrote lead author Amy Starmer, MD, MPH, Boston Children’s Hospital, Harvard Medical School, Boston. "Given the increasing frequency of handoffs in hospitals following resident work-hour reductions and the high frequency with which miscommunication leads to serious medical errors, disseminating high-quality handoff improvement programs has the potential for benefit."

"Given the known problems of discontinuity, the strong face validity of the handoff bundle, the reasonably minimal effort it involved to implement and these promising, albeit preliminary results, it would be difficult to argue that handoff bundles should not be widely adopted," Leora J. Horowitz, MD, MHS, Yale Medical School, New Haven, CT, wrote in an accompanying editorial comment. "Additional study is still needed to replicate these results, better characterize essential elements, refine the interventions and determine sustainability. While awaiting results from larger multi-institutional studies, it is reasonable to ensure that at least basic elements of safe handoffs are in place."

Keywords: Medical Errors, Patient Care, Quality of Health Care, Patient Safety

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