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Information Rush Hour: The State of Electronic Tools Used In Patient Handoffs Across Units, a Systematic Review

Author: Adriana Stanley, BS

Primary Advisor: Amy Franklin, PhD

Committee Members:

Masters thesis, The University of Texas Health Science Center School of Health Information Sciences at Houston.

Abstract:

Objective: Since patient handoffs are events at high risk to the patient’s safety due to the amount of patient information, sensitivity of the medical information and urgency in the patient’s health, studies have been performed and tools have been created to improve the transfer of information from one provider to the other. A systematic review of the literature was performed to determine what advancements have been made to improve communication and information transfer during patient handoffs across units using electronic means.

Methods: The Pubmed database was searched for articles form 1/1/1980 to 2/25/2015 using terms related to patient handoffs. Initial queries found 996 articles after using the search term “handoff” OR “handover” in the same query to search article titles. Instead of using the MeSH terms “patient handoff”, “clinical handoff” and “nursing handoff”, both terms “handoff” and “handover” were used to have the highest number of document trieval. In this review, “signout” or “signoff” was not used as a search criteria because in comparison to “handoff” or “handover”, the former allude to a complete dismissal of the patient from the hospital system. Although a “signout” is an across unit patient handoff, using this search term would exclude the more general term “handoff” which could mean both a dismissal of a patient from one inside the hospital to one outside the hospital or to the temporary transfer of responsibility of the patient to another doctor for a treatment or analysis.

To narrow the focus to only across unit handoffs, the abstract and title was reviewed. Excluded were articles not meeting this criteria (across units, electronic methods) such as those focused on shift­to­shift, or within unit handoffs. Sixty articles were included in the initial review. Next, the articles were reviewed for the format of the handoff tool, either paper or electronic based forms. Of the sixty articles on handoffs across units, 50 used paper-methods and 10 used electronic methods. Articles that focused on electronic based handoff documentation were systematically reviewed, including an in-depth review of the structure, features of the tool, guideline adherence and outcome measures including research or theory on which the tools were based.

Results: Ten articles met the inclusion criteria. Many of the articles that focused on surveys and interviews were heavily based in theory and research (50%). Other articles focused on practical application by developing software tools (50%) to help assist the patient handoff process. The survey and interview based articles (30%) focused on obtaining information and feedback from physicians and other clinicians that had experience with handoff and could give firsthand experience and insight. Articles illustrated the integration of the electronic handoff tool with an actual electronic health record (20%), showing that advancements have been made to integrate interoperability and synchrony between the handoff tool and the health record.

Conclusion: The features of handoff tools, theories used as a framework and devices used to structure the handoff tools and interviews varied significantly in their detail and application. This decreased the ability to compare the most effective handoff tool or which interview theory produced the best results that could be used during creation of a tool and effect patient outcomes over time. Future research should focus on combining the theories, techniques and features that produced the most promising results in effective handoffs with further research on how this affects patient outcomes.