Nursing Handoffs: Systematic Review of Safe Practices
This paper critically examines "Nursing Handoffs: A Systematic Review of the Literature" by Riesenberg, Leisch, and Cunningham (2010), which analyzed twenty empirical studies to identify safe and effective handoff practices in nursing care. The review covers the prevalence of adverse events linked to handoffs, the quality ratings assigned to selected studies, and the relative merits of oral versus written communication systems. The paper highlights methodological weaknesses in the original review—including inconsistent study aims, lack of evidence-quality discussion, and unclear quality-scoring rationale—while acknowledging key findings such as the potential benefits of written reporting systems and the unresolved concerns over confidentiality, patient-nurse contact, and miscommunication sources.
- Introduction to Nursing Handoffs: Defines handoffs and their clinical significance
- Scope and Quality of the Research Studies: Database selection, study types, and quality scores
- Key Findings on Handoff Interventions: Effective and ineffective handoff interventions summarized
- Oral Versus Written Reporting Systems: Comparing taped, face-to-face, and written reports
- Methodological Weaknesses of the Review: Critique of inconsistency, unclear scoring, and narrative gaps
- Unresolved Questions and Conclusions: Confidentiality, patient contact, and communication gaps
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What makes this paper effective
- Balances summary with critique — the paper consistently moves between reporting what the original review found and evaluating whether those findings are convincing, which demonstrates analytical depth.
- Grounds criticism in specific evidence — rather than making vague claims about quality, the paper cites exact quality scores and study counts to substantiate its concerns.
- Raises practical implications beyond the data — issues such as patient confidentiality, illegible handwriting, and the cost of additional paperwork extend the critique into real-world nursing policy.
Key academic technique demonstrated
The paper demonstrates evaluative synthesis: it does not simply describe the source review but interrogates its internal consistency, the rationale behind its methodology, and the gap between reported findings and actionable recommendations. This is a core graduate-level skill in evidence-based practice.
Structure breakdown
The paper opens by establishing the clinical significance of handoffs and the purpose of the review under analysis. It then moves through the review's methodology and quality scoring, summarizes key study findings, and devotes the final third to a sustained critique of methodological limitations, inconsistencies in study aims, unanswered practical questions, and the limits of the written-report recommendation. The conclusion appropriately frames the review as a useful starting point rather than a definitive evidence base.
Introduction to Nursing Handoffs
It is extremely rare that a single patient is overseen by the same nurse throughout the duration of his or her care. Nurses must also frequently communicate orders to patients and their families before the patient is discharged. Thus, nursing handoffs — a shift in care-related responsibilities — are a critical component of daily nursing practice. The purpose of the systematic research review "Nursing Handoffs: A Systematic Review of the Literature" was to determine what safe and effective practices exist regarding this aspect of nursing care, based on the evidence provided by existing empirical studies.
Handoffs are not simply a change in personnel: they are critical junctures of care where information may be lost or where important connections may be made that result in substantive improvements in patient health. In fact, handoffs are considered important enough that the Joint Commission has a specific definition for the process in its literature. Handoffs take place when "information about patient/client/resident care is communicated in a consistent manner" — either between healthcare providers or between providers and patients — for the purposes of continuity of care (Riesenberg, Leisch, & Cunningham, 2010). Communication failures, however, often result in health-related problems or medical errors during the handoff process, and more intensive research is therefore needed to determine why this occurs and how to improve it.
In their initial literature review on the subject, Riesenberg, Leisch, and Cunningham (2010) cite evidence that nearly two-thirds of all handoffs are associated with adverse events of some kind. An Australian study of more than 14,000 handoffs found that "17% were associated with an adverse event; [and] in 11% of those events, communication problems were found to be a contributing factor" (Riesenberg, Leisch, & Cunningham, 2010). Another study of medical errors during handoffs found that miscommunication between physicians and nurses was a determining factor in 37% of errors. Non-standardized communication patterns were cited as the most frequent reason for this problem — such as the differing perspectives of physicians and nurses, or errors in abbreviations when transmitting vital patient data. Given these high rates of errors, the purpose of the systematic review was to assess both the quality of existing research on handoffs and to identify best practices.
Scope and Quality of the Research Studies
Over the course of the research review, twenty studies were ultimately selected from major online medical databases: MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, CINAHL, HealthSTAR, and Christiana Care Full Text Journals@Ovid. Of these selected studies, "fifteen (75%) of the research studies involved an intervention, four (20%) were cross-sectional, and one (5%) was qualitative" (Riesenberg, Leisch, & Cunningham, 2010).
To assess research quality, the authors used an objective, empirically validated external instrument called the Quality Scoring System. Quality assessment scores for the twenty studies ranged from 2 to 12, on a possible scale of 1 to 16. Many — though not all — of the studies concerned quality improvement projects. The majority of studies (17 of 20, or 85%) received quality scores at or below 8, with nine receiving scores between 2 and 5 and eight receiving scores between 6 and 8. Only three studies achieved quality scores above 10, with scores of 10.5, 11, and 12 (Riesenberg, Leisch, & Cunningham, 2010). Overall, this pattern suggests a relatively low level of quality in the existing research on the subject. It should be noted that the instrument was not designed specifically to evaluate these studies; it had previously been used to rate research studies across a variety of subjects.
Key Findings on Handoff Interventions
After reviewing the quality ratings, the authors briefly discussed some of the most pertinent studies. They noted that only half of the studies identified interventions that appeared to be effective, and some of these were highly specific to particular patient populations. For example, one study of handoffs involving pediatric patients found that parental input was helpful when nurses engaged in rotations. Another study found that verbal patient participation in shift reports — as opposed to recorded shift reports — enhanced patients' sense of well-being, although the efficacy of care itself was not studied.
Other studies found a reduced need for nurse overtime and reduced stress levels for both nurses and patients with "the implementation of walking rounds, bedside shift reports, or a customized telephone-based system," which in conjunction improved the accuracy of patient information (Riesenberg, Leisch, & Cunningham, 2010). Reducing occupational stress in nursing is recognized as an important dimension of patient safety, and these findings suggest that structural handoff reforms can contribute to that goal.
References
Riesenberg, L., Leisch, J., & Cunningham, J. (2010). Nursing handoffs: A systematic review of the literature. AJN, 110(4), 24–34.
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