Patient handoffs: standardized and reliable measurement tools remain elusive

Jt Comm J Qual Patient Saf. 2010 Feb;36(2):52-61. doi: 10.1016/s1553-7250(10)36011-9.


Background: Numerous quality improvement projects on patient handoffs have been conducted, yet standardized, reliable measurement tools remain elusive.

Handoff quality measures classified by primary handoff purpose: The literature review, which yielded approximately 400 relevant articles, led to the identification of seven primary functions for patient handoffs, each of which implies different interventions to improve them: (1) Framing 1, information processing is the most prevalent in the patient handoff literature; (2) Framing 2, stereotypical narratives, emphasizes highlighting deviations from typical narratives, such as a patient who is allergic to the preferred antibiotic for treating his or her diagnosed condition; (3) Framing 3, resilience, takes advantage of the transparency of the thought processes revealed through the conversation to identify erroneous assumptions and actions; (4) Framing 4, accountability, emphasizes the transfer of responsibility and authority; (5) Framing 5, social interaction, considers the perspective of the participants in the exchange; (6) Framing 6, distributed cognition, addresses how a transfer to a new care provider affects a network of specialized practitioners performing dedicated roles who may or may not be transitioning at the same time; (7) Framing 7, cultural norms, relates to how group values (instantiated as social norms for acceptable behavior) in an organization or suborganization are negotiated and maintained over time.

Discussion: The diversity of handoff measurement approaches suggests a lack of consensus about the primary purpose of a handoff, as well as about what interventions are most promising for improving handoff processes. Recognizing that there are simultaneously multiple purposes for handoffs is a critical precursor to quality improvement.

Publication types

  • Review

MeSH terms

  • Continuity of Patient Care / standards*
  • Humans
  • Process Assessment, Health Care*
  • Quality Assurance, Health Care
  • Workflow*