Affiliations: Department of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA | Department of Performance Improvement, Children's National Medical Center, Washington, DC, USA
Note: [] Address for correspondence: David C. Stockwell, MD, MBA, Department of Critical Care Medicine, Children's National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010, USA. Tel.: +202 476 2130; Fax: +202 476 5724; E-mail: dstockwell@childrensnational.org
Abstract: Background: The transfer of care from one provider to another is fraught with potential failures. Unfortunately the consequences of a poorly conducted patient handoff can be quite high. In the last five years there have been many descriptions of this problem as well as suggested solutions. Commonly authors have focused on utilization of a formatted tool for the off-going provider to help improve patient handoffs. While this is certainly a requirement for a high quality transfer of care, it is not the only needed component. Objectives: We seek to describe a novel approach to handoffs and focus on the early findings from our pilot projects. Methods: The handoff typically involves two clinicians; an off-going or sending provider and an oncoming or receiving provider, there are therefore dual responsibilities in performing a high quality handoff. The off-going provider should structure their patient handoff in an easily assimilable format as earlier work has described. However a high quality handoff also needs to set the expectation that the oncoming provider must be certain that they have heard the relevant patient information. Therefore a tool to assist with this process is warranted. We describe our early experience of utilization of a structured handoff receiver tool. Results: Clinicians report higher quality handoffs as a result of the addition of the dual responsibility handoff. Use of the I-5 Tool improved transfer of care. Also early results suggest that there are failures in care that would have occurred without this intervention. Conclusions: Early results from pilot testing reveal after designing and testing the dual responsibility model that patient handoffs are increasingly successful and more reliable.
