Feedback and Assessment Tools for Handoffs: A Systematic Review.

BACKGROUND: Resident handoff communication skills are essential components of medical education training. There are no previous systematic reviews of feedback and evaluation tools for physician handoffs. OBJECTIVE: We performed a systematic review of articles focused on inpatient handoff feedback or assessment tools. METHODS: The authors conducted a systematic review of English-language literature published from January 1, 2008, to May 13, 2015 on handoff feedback or assessment tools used in undergraduate or graduate medical education. All articles were reviewed by 2 independent abstractors. Included articles were assessed using a quality scoring system. RESULTS: A total of 26 articles with 32 tools met inclusion criteria, including 3 focused on feedback, 8 on assessment, and 15 on both feedback and assessment. All tools were used in an inpatient setting. Feedback and/or assessment improved the content or organization measures of handoff, while process and professionalism measures were less reliably improved. The Handoff Clinical Evaluation Exercise or a similar tool was used most frequently. Of included studies, 23% (6 of 26) were validity evidence studies, and 31% (8 of 26) of articles included a tool with behavioral anchors. A total of 35% (9 of 26) of studies used simulation or standardized patient encounters. CONCLUSIONS: A number of feedback and assessment tools for physician handoffs in several specialties have been studied. Limited research has been done on the studied tools. These tools may assist medical educators in assessing trainees' handoff skills.

Shift-to-Shift Handoff Effects on Patient Safety and Outcomes.

Multiple health care organizations have identified handoffs as a source of clinical errors; however, few studies have linked handoff interventions to improved patient outcomes. This systematic review of English-language research articles, published January 2008 to May 2015 and focusing on shift-to-shift handoff interventions and patient outcomes, yielded 10 774 unique articles. Twenty-one articles met inclusion criteria, measuring each of the following: patient falls (n = 7), reportable events (n = 6), length of stay (n = 4), mortality (n = 4), code calls (n = 4), medication errors (n = 4), medical errors (n = 3), procedural complications (n = 2), pressure ulcers (n = 2), weekend discharges (n = 2), and nosocomial infections (n = 2). One study each also measured time to first intervention, restraint use, overnight transfusions, and out-of-hours deteriorations. Studies that reported funding had higher quality scores. It is difficult to identify trends in the handoff research because of simultaneous implementation of multiple interventions and heterogeneity of the interventions, outcomes measured, and settings. The authors call for increased handoff research funding, especially for studies that include patient outcome measures.

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review.

BACKGROUND: Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. OBJECTIVE: This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. METHODS: We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. RESULTS: Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. CONCLUSIONS: The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.