Safer Patient Handoffs - Resources

From The Joint Comission

Common Terminology and Definitions

An adverse event is an injury caused by medical management–rather than by the underlying disease–which prolongs hospitalization, produces a disability at the time of discharge, or both.

McGraw-Hill Concise Dictionary of Modern Medicine. via, as accessed July 10, 2015.

In nursing usage, an adverse event is an injury resulting from a patient's medical management rather than from the underlying condition itself.

Medical Dictionary for the Health Professions and Nursing, via, as accessed July 10, 2015.

The term “adverse event” describes harm to a patient as a result of medical care, such as infection associated with use of a catheter.

....[an] “adverse medical event or error”...[is] one that causes an injury to a patient as the result of a medical intervention rather than the underlying medical condition. It represents an unintentional harm to a patient arising from any aspect of healthcare management.

Bedside nurse shift report is a process where nurses provide shift-to-shift report at the patient’s bedside so the patient can be more involved in his or her care. There are many benefits of bedside report, including relationship building between staff members and increased patient satisfaction...

The term care transition describes a continuous process in which a patient's care shifts from being provided in one setting of care to another, such as from a hospital to a patient's home or to a skilled nursing facility and sometimes back to the hospital. Poorly managed transitions can diminish health and increase costs. Researchers have estimated that inadequate care coordination, including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.

The core components of handoffs include:

  • Verbal Communication
    • In person or over phone
    • Written communication
  • “Transition Record”
    • Discharge summary
    • Admission or Transfer note
    • Signout
  • Transfer of Professional Responsibility

Handoff communication, which includes up-to-date information regarding patient care, treatment and service, condition, and any recent or anticipated changes, should be interactive to allow for discussion between those who give and receive patient information. It requires a process for verification of the received information, including read-back or other methods, as appropriate.

Handoff communication ‘refers to a real-time process of passing patient/client/resident-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient/client/resident’s care.’

FAQ’s for the Joint Commission’s 2007 national patient safety goals. The Joint Commission, 2007.

A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.

In nursing usage, a medical error is any failure to implement a planned action as intended or the implementation of the wrong nursing plan.

Medical Dictionary for the Health Professions and Nursing via, as accessed July 10, 2015.

Medical handover is ‘the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis’.

Handovers permeate the health-care system and can occur at shift changes, when clinicians take breaks, when patients are transferred within and between hospitals and during admission, referral or discharge. Effective patient handover is critical to patient safety by ensuring appropriate coordination among health-care providers and continuity of care.

In nursing, a change-of-shift report is a meeting between nursing staff members at the change of shift in which patient information is exchanged. Report is generally given by the nurses in charge of one shift to those coming on for the next, and in some facilities, nurse assistants participated in report, though the charge nurse is primarily responsible for making the report. During report, the outgoing nurses discuss with the oncoming nurses the condition of each patient and any changes that have occurred to the patient during the shift. The purpose is not to cover all details recorded in the patient's medical record, but to summarize individual patient progress. Most reports will include new arrivals, discharges, and deaths.

The nursing shift report is a nursing intervention defined as exchanging essential patient care information with other nursing staff at change of shift.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition via, as accessed July 8, 2015.

The handoff can be thought of as a communication of information (content) that can take place through different modalities, which can include a written or verbal component.

The primary objective of a “hand off” is to provide accurate information about a patient’s care, treatment, and services, current condition and any recent or anticipated changes. The information communicated during a hand off must be accurate in order to meet patient safety goals. In health care there are numerous types of patient hand offs, including but not limited to nursing shift changes, physicians transferring complete responsibility for a patient, physicians transferring on-call responsibility, temporary responsibility for staff leaving the unit for a short time, anesthesiologist report to post-anesthesia recovery room nurse, nursing and physician hand off from the emergency department to inpatient units, different hospitals, nursing homes and home health care, critical laboratory and radiology results sent to physician offices.

2007 National Patient Safety Goals, Joint Commission on Accreditation of Healthcare Organizations.

Our working definition for a patient handoff is as follows: “The process of transferring primary authority and responsibility for providing clinical care to a patient from one departing caregiver to one oncoming caregiver.” Caregivers include attending physicians, resident physicians, physician assistants, nurse practitioners, registered nurses, and licensed practitioner nurses. It is assumed that the patient handoff is conducted between caregivers at comparable levels of experience and expertise and who are at equivalent levels of a hierarchy (for example, attending physician to attending physician). Examples of handoffs using this definition are as follows:

  • Nursing shift changes
  • Physician sign-outs
  • Physician-to-physician transfers during a tour of duty to balance workload
  • Nurse-to-nurse transfers during a shift to balance workload

Following a handoff, the oncoming caregiver assumes the responsibility for providing care..."

Sign-out is a mechanism of transferring information, responsibility, and authority from one set of caregivers to another set of caregivers. The primary objective of sign-out is the accurate transfer of information about a patient’s state and plan of care from one set of health care providers to another. At the conclusion of an effective sign-out, caregivers should have a clear mental picture of the patients for whom they are assuming care, know the current status and plan of care for those patients, and have a sense of what problems and issues may arise during the next shift.

A transition of care (“handoff”) is defined as the communication of information to support the transfer of care and responsibility for a patient/group of patients from one service and/or team to another. The transition/hand-off process is an interactive communication process of passing specific, essential patient information from one caregiver to another. Transition of care occurs regularly under the following conditions:

  • Change in level of patient care, including inpatient admission from the ambulatory setting, outpatient procedure, or diagnostic area
  • Inpatient admission from the Emergency Department
  • Transfer of a patient to or from a critical care unit
  • Transfer of a patient from the Post Anesthesia Care Unit (PACU) to an inpatient unit when a different physician will be caring for that patient
  • Transfer of care to other healthcare professionals within procedure or diagnostic areas
  • Discharge, including discharge to home or another facility such as skilled nursing care
  • Change in provider or service change, including resident sign-out, inpatient consultation sign-out, and rotation changes for residents

Transitional care refers to the coordination and continuity of healthcare during a movement from one healthcare setting to either another or to home, called care transition, between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.