Handoffs are key events in the care of hospitalized patients. Failures in communication at the time of patient handoff have been implicated as contributing factors to preventable adverse events. Standardization of handoff has been proposed as a way to mitigate these breakdowns in communication. Whether standardized handoff results in improved patient outcomes is unknown. We compared the clinical outcomes of patients admitted to inpatient internal medicine services with and without a standardized handoff procedure.
We reviewed the electronic medical record of 1578 patients admitted to inpatient general internal medicine services during one calendar year at our institution, a large academic tertiary referral hospital. Patients admitted during the evening duty period and transitioned to the care of daytime providers without a standardized handoff were compared to those admitted during the night duty period and transitioned to the care of daytime providers with a standardized face‐to‐face handoff. Primary outcomes included occurrence of rapid response team calls, code team calls, transfers to a higher level of care, deaths in hospital, and adverse events, as identified using the Global Trigger Tool. Secondary outcomes included length of stay and 30‐day readmission rate. Statistical analysis of primary and secondary outcomes utilized Fischer’s exact test for categorical variables and Student’s t‐test for continuous variables. Global Trigger Tool data were compared using a negative binomial regression model.
There was no significant difference between the groups with respect to demographics, Charlson comorbidity index, or medical comorbidities at baseline (Table 1). There was no significant difference between groups with respect to the frequency of rapid response team calls, code team calls, transfers to a higher level of care, deaths in hospital, or adverse events (Table 2). There was a trend to a higher 30‐day readmission rate in the group with standardized handoff (P = 0.05). Patients without standardized handoff had a significantly longer length of stay (P< 0.001).
No differences in the primary outcomes were identified in this study when comparing the groups with and without standardized handoff. Providers may rely on the electronic medical record or patient interviews when face‐to‐face handoff is not available in order to ensure patient safety and a smooth care transition. Additional study is necessary to determine the full impact of handoff on patient safety and clinical outcomes.
To cite this abstract:Schouten W, Jones L, Burton M, Newman J, Kashiwagi D. Comparison of Patient Outcomes with and Without a Standardized Handoff Procedure. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 163. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/comparison-of-patient-outcomes-with-and-without-a-standardized-handoff-procedure/. Accessed April 9, 2020.