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Residents’ and Attending Physicians’ Handoffs: A Systematic Review of the Literature

Riesenberg, Lee Ann PhD, RN; Leitzsch, Jessica; Massucci, Jaime L. MD; Jaeger, Joseph MPH; Rosenfeld, Joel C. MD, MEd, FACS; Patow, Carl MD, MPH, MBA; Padmore, Jamie S.; Karpovich, Kelly P.

doi: 10.1097/ACM.0b013e3181bf51a6
Quality and Safety

Purpose Effective communication is central to patient safety. There is abundant evidence of negative consequences of poor communication and inadequate handoffs. The purpose of the current study was to conduct a systematic review of articles focused on physicians’ handoffs, conduct a qualitative review of barriers and strategies, and identify features of structured handoffs that have been effective.

Method The authors conducted a thorough, systematic review of English-language articles, indexed in PubMed, published between 1987 and June 2008, and focused on physicians’ handoffs in the United States. The search strategy yielded 2,590 articles. After title review, 401 were obtained for further review by trained abstractors.

Results Forty-six articles met inclusion criteria, 33 (71.7%) of which were published between 2005 and 2008. Content analysis yielded 91 handoffs barriers in eight major categories and 140 handoffs strategies in seven major categories. Eighteen articles involved research on handoffs. Quality assessment scores for research studies ranged from 1 to 13 (possible range 1–16). One third of the reviewed research studies obtained quality scores at or below 8, and only one achieved a score of 13. Only six studies included any measure of handoff effectiveness.

Conclusions Despite the negative consequences of inadequate physicians’ handoffs, very little research has been done to identify best practices. Many of the existing peer-reviewed studies had design or reporting flaws. There is remarkable consistency in the anecdotally suggested strategies; however, there remains a paucity of evidence to support these strategies. Overall, there is a great need for high-quality handoff outcomes studies focused on systems factors, human performance, and the effectiveness of structured protocols and interventions.

Dr. Riesenberg is director of medical education research and outcomes, Academic Affairs, Christiana Care Health System, Newark, Delaware, and research assistant professor, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.

Ms. Leitzsch is research assistant, Academic Affairs, Christiana Care Health System, Newark, Delaware.

Dr. Massucci is an emergency medicine administrative fellow, Christiana Care Health System, Newark, Delaware.

Mr. Jaeger is associate vice president, Academic Affairs, Monmouth Medical Center, Long Branch, New Jersey, and associate dean, Academic Affairs, Monmouth Programs, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Dr. Rosenfeld is chief academic officer, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania, and associate dean, Temple University School of Medicine, Philadelphia, Pennsylvania.

Dr. Patow is executive director, HealthPartners Institute for Medical Education, and associate dean for faculty affairs, Regions Hospital, University of Minnesota Medical School, Minneapolis, Minnesota.

Ms. Padmore is assistant vice president, Academic Affairs, MedStar Health, Columbia, Maryland.

Ms. Karpovich is director, Medical Education-Baltimore, MedStar Health, Columbia, Maryland.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Riesenberg, Academic Affairs, Christiana Care Health System, 4755 Ogletown-Stanton Road, MAP 2, Suite 2114, Newark, DE 19718; telephone: (302) 623-4488; fax: (302) 623-4485; e-mail: (

© 2009 Association of American Medical Colleges