Objective: Handoffs of patient care from one nurse to another are an integral part of nursing practice; but there is abundant evidence that poor communication and variable procedures result in inadequate handoffs. We sought to conduct a systematic review of articles that focused on nursing handoffs, conduct a qualitative review of barriers to and strategies for effective handoffs, and identify features of structured handoffs that have been effective.
Methods: We conducted a systematic review of English-language articles, published between January 1, 1987, and August 4, 2008, that focused on nursing handoffs in the United States. The search strategy yielded 2,649 articles. After title review, 460 of these were obtained for further review by trained abstractors.
Results: Ninety-five articles met the inclusion criteria; of these, 55 (58%) were published between January 1, 2006 and August 4, 2008. Content analysis yielded identification of barriers to effective handoffs in eight major categories and strategies for effective handoffs in seven major categories. Twenty articles involved research on nursing handoffs. Quality assessment scores for the research studies ranged from 2 to 12 (possible range, 1 to 16). The majority of the research studies on nursing handoffs (17 studies; 85%) received quality scores at or below 8 and only three achieved scores above 10. Ten (50%) of the studies included measures of handoff effectiveness.
Conclusion: Despite the well-known negative consequences of inadequate nursing handoffs, very little research has been done to identify best practices. There is remarkable consistency in the anecdotally suggested strategies; but there is a paucity of evidence to support them. We call for high-quality studies of handoff outcomes that focus on systems factors, human performance, and the effectiveness of structured protocols and interventions.
This qualitative review highlights the barriers to and strategies for effective handoffs.
Lee Ann 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. Jessica Leitzsch is research assistant, Academic Affairs, and Janet M. Cunningham is vice president professional excellence and associate chief nursing officer, both at Christiana Care Health System. The authors acknowledge Ellen M. Justice, MLIS, AHIP, medical librarian of the Lewis B. Flinn Medical Library, Christiana Care Health System, for conducting literature searches; Dolores Ann Moran and Janice Evans, each a medical library assistant II, for assistance in locating articles; and Donald Riesenberg, MD, for reviewing the manuscript.
Contact author: Lee Ann Riesenberg, firstname.lastname@example.org. The authors have disclosed that they have no financial interests in any commercial company related to this educational activity.