Patient Hand-Off iNitiation and Evaluation (PHONE) study: A randomized trial of patient handoff methods

Am J Surg. 2017 Feb;213(2):299-306. doi: 10.1016/j.amjsurg.2016.10.015. Epub 2016 Nov 23.


Background: As residency work hour restrictions have tightened, transitions of care have become more frequent. Many institutions dedicate significant time and resources to patient handoffs despite the fact that the ideal method is relatively unknown. We sought to compare the effect of a rigorous formal handoff approach to a minimized but focused handoff process on patient outcomes.

Methods: A randomized prospective trial was conducted at a large teaching hospital over ten months. Patients were assigned to services employing either formal or focused handoffs. Residents were trained on handoff techniques and then observed by trained researchers. Outcome data including mortality, negative events, adverse events, and length of stay were collected and compared between formal and focused handoff groups using t-tests and a multivariate regression analysis.

Results: A total of 5157 unique patient-admissions were stratified into the two study groups. Focused handoffs were significantly shorter and included fewer patients (mean 6.3 patients discussed over 6.7 min vs. 35.2 patients over 20.6 min, both p < 0.001). Adverse events occurred during 16.7% of patient admissions. While overall length of stay was slightly shorter in the formal handoff group (5.50 days vs 5.88 days, p = 0.024) in univariate analysis only, there were no significant differences in patient outcomes between the two handoff methods (all p > 0.05).

Conclusions: This large randomized trial comparing two contrasting handoff techniques demonstrated no clinically significant differences in patient outcomes. A minimalistic handoff process may save time and resources without negatively affecting patient outcomes.

Keywords: Medical errors; Patient handoff; Patient outcomes; Patient safety; Physician communication; Sign-out.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Female
  • Hospitals, Teaching
  • Humans
  • Internship and Residency*
  • Length of Stay
  • Male
  • Medical Errors / prevention & control
  • Middle Aged
  • Patient Handoff / organization & administration*
  • Patient Outcome Assessment
  • Patient Safety
  • Prospective Studies
  • United States