Nursing Handoff Communication: Problems and Solutions

Introduction

Nursing handoffs are important components of the modern healthcare setting given their role in transferring the responsibility and authority of care from one practitioner to another during shift changes. Generally, nurses work in different shifts when providing patient care in order to reduce their workload and potential stress. Nursing handoffs therefore help ensure continuity of care during a patient's stay in a healthcare facility.

Despite the significance of nursing handoffs in continuity of care, this process has been characterized by numerous communication problems. In most cases, nursing handoffs are substandard and contribute to several challenges in enhancing patient outcomes and satisfaction. This study seeks to examine communication problems in nursing handoffs with a view to identifying effective strategies for improving this process. This issue is important in current nursing practice with regard to enhancing patient outcomes and satisfaction. Effective nursing handoffs are achieved through proper communication strategies and processes that promote continuity of care.

Background and Significance of the Problem

Handoffs are essential elements that serve various functions including social bonding, team building, and coaching and teaching. In the healthcare setting, nursing handoffs play an important role with regard to information processing — that is, ensuring that essential information is transferred for patient safety. This means that nursing handoffs are important in maintaining continuity of care during a patient's stay in a healthcare facility. Handoffs act as communication links between the various medical personnel providing patient care.

Despite their significance in continuity of care and patient safety, nursing handoffs have recently been characterized by errors, care omissions, inefficiencies, increased costs, prolonged hospital stays, preventable re-hospitalizations, and unsuitable treatment (Halm, 2013, p. 158). This is primarily because they are carried out in a substandard or highly variable manner. This is a major issue that requires examination in order to identify suitable measures for improving nursing handoffs with the aim of improving patient safety and promoting continuity of care.

Variable or substandard nursing handoffs have contributed to several issues that affect patient safety and the quality of treatment. These types of handoffs arise from various inefficiencies and communication problems during the process. The critical question, therefore, is why inadequate nursing handoffs continue to occur despite their devastating impacts on patient care. The purpose of this study is to develop effective measures for improving nursing handoffs in order to enhance patient care and outcomes. The study will entail examining the major issues that contribute to substandard or variable handoffs, the impact of inadequate nursing handoffs, and suitable measures for improving them.

Literature Review

The main purpose of nursing handoff is to communicate patient information in order to ensure safe, continuous care. Given its significance in patient care, nursing handoff has received considerable attention in the nursing field. This significant attention has been fueled by the fact that handoff is widely recognized as a trouble spot in ensuring continuity of care and patient safety. Researchers have examined numerous issues, particularly those related to communication during nursing handoffs.

The significance of nursing handoff in ensuring continuity of care and patient safety has long been established. According to Popovich (2011), the main function of handoffs in nursing practice is to communicate patient information, which serves as the foundation for ensuring safe, continuous care (p. 55). This researcher argues that patient safety is the most important component of nursing handoff in relation to promoting continuity of care when essential information and responsibility for a patient's care is transferred from one healthcare provider to another.

This view is supported by Abraham et al. (2011), who argue that nursing handoff plays a vital role in ensuring the continuity of patient care activities (p. 28). These researchers attribute the significance of nursing handoff in patient safety to its role as a crucial clinical and organizational process that takes place at every level of the hospital. They further contend that the significance of nursing handoff in patient safety is evident in its three major aspects: transfer of information, transfer of responsibility, and transfer of authority.

In support of these claims, Farhan et al. (2011) posit that ensuring the safe transition of shift responsibility from the outgoing to the incoming healthcare provider is one of the basic functions of nursing handoffs (p. 1). However, these researchers state that this can be achieved only through precise communication of information at the end of a shift. Unlike Popovich (2011) and Abraham et al. (2011), Farhan et al. (2011) examine the significance of nursing handoff in patient safety on the basis of information and responsibility transfer alone, without including authority. They consider nursing handoff as the transfer of patient information and/or departmental responsibility to help promote continuity of care and patient safety.

Abraham et al. (2011) state that nursing handoffs remain a major threat to patient safety and continuity of care despite their vital role in promoting patient care activities (p. 28). As a result, nursing handoffs have been regarded as remarkably haphazard, since they sometimes contribute to patient harm instead of safety. Farhan et al. (2011) concur with Abraham et al. (2011) by arguing that studies have shown that poor nursing handoffs were the most widespread cause of medical errors due to teamwork problems. While standardization of handoff structure and formal training have been adopted to enhance this nursing practice, handoffs are still characterized by poor quality, as evidenced by the frequency of medical errors that negatively affect patient safety and continuity of care.

Blouin (2011) agrees with these researchers, stating that each nursing handoff presents a unique opportunity for medical errors even though its primary objective is to promote safe, continuous care through accurate patient information (p. 97). In a study examining the root causes of poor nursing handoffs, Popovich (2011) identifies communication problems as the major factors hindering the effectiveness of handoffs (p. 56). Abraham et al. (2011) share this view, arguing that communication failures have been identified as the leading causes of a series of clinical errors and adverse events during patient care (p. 28). They report that approximately 50% of communication failures during nursing handoffs occur between care providers.

Blouin (2011) also states that communication challenges are the root causes of unprecedented outcomes in nursing handoffs (p. 97), supporting this claim with findings from a study that concluded approximately 80% of serious clinical errors involve miscommunication between caregivers during care delivery transitions. Sentinel events reported to the Joint Commission between 1995 and 2006 were attributable to communication failures during transitions of care or nursing handoffs.

Even though they recognize the importance of accurate communication, Farhan et al. (2011) attribute poor transitions of care to factors beyond communication alone. They argue that poor nursing handoffs are caused by a lack of standardized structure and practice. Research has shown that a gap exists between evidence and practice during nursing handoffs, which seemingly hinders the ability to standardize this important component of clinical practice. Moreover, the current healthcare system lacks a robust mechanism through which safe handoff of responsibility can reliably take place, and this gap contributes to medical errors.

While these researchers agree that communication failures are the major causes of poor care transitions, they offer different recommendations for improving nursing handoff communication. Farhan et al. (2011) propose the establishment of a simple tool to provide a framework for nursing handoffs (p. 1). The simple tool incorporates medical and operational information vital to the efficiency and organization of the subsequent shift. The authors further propose the use of the ABC tool as part of a robust system and standardized structure to enhance nursing handoff.

Abraham et al. (2011) agree with Farhan et al. (2011) that standardization through a handoff communication tool would help address problems associated with care transitions. However, Abraham et al. (2011) suggest that such a tool should be based on a body-system format, which enables classification of patient care information according to body systems in order to eliminate variability in the content and form of the current handoff process (p. 34). They further recommend that the handoff communication tool be accompanied by strategies for streamlining pre-turnover activities through an information-push model, in which relevant information is sent to users without requiring them to explicitly request it.

Popovich (2011) provides several recommendations to improve nursing handoff communication, including assuming responsibility for a patient, verifying the patient's surroundings, and determining the patient's condition and existing or pending treatments. Additional measures include identifying specific times when nursing handoffs occur and examining handoff procedures to identify effective practices across diverse situations.

Blouin (2011) recommends the SHARE model as a probable solution for improving nursing handoff communication. This model involves standardizing critical content, identifying and utilizing existing and new technologies within the care delivery system, allowing for questions, reinforcing quality and measurement, and educating and coaching. Implementation can be achieved through assuming a leadership role and participating in organization-wide efforts.