Faculty & Clinical Affairs

Alan P. Marco, M.D., M.M.M., Associate Dean
Albert F. Painter Jr., Psy.D., Assistant Dean

Wright State University Boonshoft School of Medicine
Sponsored Graduate Medical Education Programs
Resident Manual

Item 512
Patient Handoff Communication Policy
Adopted: June 2013

Purpose

To provide guidance on, and expectations for the development and implementation of a standardized process for handoff communication to ensure effective information transfer among providers during handoff with the overarching goal of minimizing the potential for medical errors.  The primary objective of handoff communication is to provide accurate information about a patient’s care, treatment, and services, current condition, and any recent or anticipated changes.

The Joint Commission requires all health care providers to “implement a standardized approach to handoff communications including an opportunity to ask and respond to questions” (2006 NPSG 2E).   The Accreditation Council for Graduate Medical Education also requires that residency programs maintain formal educational programs in handoff and care transitions. 

Definitions

Communication:  the process by which information is exchanged between individuals, groups, and organizations.  In order to be effective, communication should be complete, clear, concise, and timely.

Handoff (as addressed in this policy):  the process of transferring patient information and knowledge, along with authority and responsibility, from one clinician or team of clinicians to another clinician or team of clinicians during routine changes of duty assignment. 

Signout:  as defined by the Agency for Healthcare Research and Quality (AHRQ) is used to refer to the act of transmitting information about the patient.

Transition of care: Patient movement from one area or level of care to another (e.g. emergency department to inpatient admission, general medical floor to intensive care).  Such transitions are addressed in other hospital and program policies.

Policy

Patient care responsibilities are shared among many team members including, but not limited to, residents and fellows (hereafter referred to as “residents”).  When a resident completes an assigned period of duty or prepares to leave the hospital/clinic to take care of other responsibilities, he/she is expected to “sign out” to the resident or attending assuming care for all assigned patients.

It is understood that specific handoff procedures will vary from one discipline to another and from one practice site to another.  This policy outlines general principles and expectations for patient handoff, with the adoption of specific process and form to be determined by each program and site.  Although no specific requirements are mandated, The Joint Commission provides guidelines for the development of the handoff process.  Each program and site will develop its own standardized process and incorporate The Joint Commission guidelines to include the following:

  1. Interactive communication between the giver and receiver of patient information, including an opportunity for the receiver to ask for clarification of any issues or items presented.
  2. A system for providing updated information regarding each patient’s condition, treatment, and anticipated needs during the coverage period.
  3. A strategy to minimize interruptions during the handoff process.

It is expected that every program will develop the handoff process to include the following items:

  1. To whom each resident will sign out and whether handoff includes transfer of an on-call phone or pager.
    Examples:
    • Intern to intern, senior to senior – handoff phone and code pager
    • Fellow to attending
    • Team to team
  2. A location that will minimize interruptions
    1. For many programs this will be a standard time and location for handoffs
      Examples:
      • 7:30 a.m. and 4:30 p.m. in the 6th floor conference room
      • Department conference room: all at 6:30 a.m., overnight at 11:30 a.m., short call at 5:30 p.m.
    2. For other programs, a mutually agreed upon time and location that will minimize interruptions to the handoff process
  3. Standardized handoff content (consider inclusion of a standard hard copy [see sample] or electronic “signout form” with discipline-specific details for each patient as written communication may assist the person conveying clinical information in organizing his/her thoughts and presenting important details, and provides the receiving party  hard copy information for future reference).  The most effective handoff of patient information includes both verbal and written components.  Although the exact content may vary from one program to another most will likely include the following:
    1. Demographic information: name, room number, date of birth, medical record number
    2. Code status
    3. Reason for admission and active problem list
    4. Consultants currently involved in care
    5. Current medications (if not readily available from Electronic Medical Record)
    6. Allergies
    7. Selected specific therapeutics: oxygen or ventilator settings, dietary restrictions, NPO status for imaging study
    8. Expected action items (lab results, improvement in symptoms) and intended response.  Examples:
      • If 9:00 p.m. Hgb < 7, transfuse one unit PRBC
      • If BP systolic consistently > 180, resume labetalol drip
      • If temperature > 101F, no need for additional cultures
    9. Special family or communication issues.  Examples:
      • Minor children – custody or guardian
      • Non-English speaking, available translator
    10. Responsible attending physician, how to contact, and specific expectations for updates

If signout forms are used, they must be maintained in a confidential manner. Examples: specific document in the electronic medical record system, password protected document (Word, Excel, etc.) on a single computer workstation, handwritten hard copy passed directly from one resident to another. 

Signout forms must never be:

  1. Sent by unencrypted email, even through a hospital system
  2. Left in a publicly accessible mailbox or other “drop area”
  3. Copied for or sent to unauthorized users
  4. Disposed of in non-confidential trash receptacles

Every program is expected to monitor the handoff process.  Faculty should seek feedback from residents to make changes that will enhance the ability to cross-cover residents to deliver care as intended by the primary team.  Residents should share ideas that will improve the quality of information delivered so covering residents can more easily adjust therapy based on changes in patient condition.  The handoff processes should be revised as needed for ongoing improvement in the quality and safety of patient care.