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different types of distractions and have different
priorities while giving or receiving the handoff.
We acknowledge limitations of our study, which
is an observational study at a single institution. We
did not analyze patient outcomes to determine any
correlation between quality of handoff delivery or
reception and presence of distractions and adverse
patient outcomes. Future studies should focus on
the content and quality of the message being
delivered or received, evaluate patient complica-
tions due to hand-off related issues, and lead to the
design and validation of interventions that target
the various components of the handoff process.
Based on our results, we plan to implement a
system that minimizes the number of distractions
during handoffs. This will include limiting nurse
calls during handoffs, minimizing use of unrelated
electronic devices, and minimizing hierarchy. Our
institution has received IRB approval for the second
phase of this study that will evaluate the impact of
handoff quality on patient care and study the impact
of implementing a “sterile-cockpit” approach to
patient handoffs.
In conclusion, studying the handoff process within
an established framework highlights factors that
impair communication. Internal and external dis-
tractions are common during handoffs and, along
with the working relationship between the source and
receiver, impact the quality of the handoff process.
This information allows further study and targeted
interventions of the handoff process to improve
overall handoff effectiveness and patient safety.
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