Barriers and facilitators to nursing handoffs: Recommendations for redesign

During a handoff, communication errors can lead to adverse events and suboptimal patient care. As a result, many institutions want to redesign their handoff processes, but have little specific guidance from the literature. We examined two approaches to nursing end-of-shift reports both taped and written, to identify specific factors limiting and facilitating such handoffs. Twenty nurses were interviewed using a semistructured format. They were asked about the current reporting process, the limitations, the elements that helped, and ideas for improvement. Analyses revealed that inadequate information, inconsistent quality, limited opportunity to ask questions, equipment malfunction, insufficient time to generate reports, and interruptions, limited handoffs. Facilitators were "pertinent" content, notes and space for notes, face-to-face interaction, and structured form/checklist. Recommendations for redesign are defining content pertinent to the unit, structuring handoffs so that information is received in a standard way, embedding an opportunity for questions into the process, planning for all 3 handoff subprocesses, and conducting peer evaluations and education.