Although it sounds simple, effective communication exchange is complicated and failures in this area have been a longstanding problem in healthcare. Unfortunately, the literature shows that gaps in handoff continue to contribute to errors and patient harm. Handoff is the transfer of patient care from one provider or team to the next and involves the exchange of pertinent care information.
“The Joint Commission’s sentinel event database includes reports of inadequate hand-off communication causing adverse events, including wrong-site surgery, delay in treatment, falls, and medication errors”(Joint Commission, 2017, p.2). This is compounded by the volume of handoffs that occur on a regular basis among all disciplines within the hospital. The average number of handoffs per day for a typical teaching hospital has been estimated to be 4,000 (Joint Commission, 2017). This frequency significantly increases the chances of critical information being left out or miscommunication occurring.
One solution to this problem is the use of standardized communication tools, in which the same format is used every time, for effective handoffs. This approach enables the exchange of complete, clear, and concise information. Handoffs and the use of standardized communication tools including SBAR, I-PASS The Baton, and I-PASS will be discussed in more detail in this article.
Handoffs
Handoffs have also been referred to as handover, sign-out, shift report, and cross-coverage. Effective handoffs should be in real-time, accurate, complete, free of distractions, timely, and conducted in a standardized format. Using a structured format helps to direct the conversation to the facts pertinent to patient care and not extraneous information (it’s easy to get off-track or miss something!).
SBAR
SBAR was developed by the military and integrated into healthcare as a strategy to improve communication and reduce errors. Although SBAR can and is used during handoff and care transitions, it was originally designed as a means of communicating time-sensitive, critical information that required immediate action.
See below for a description and example of SBAR.
| Description | Example |
| S: Situation: describe current condition with the patient | Doctor, I’m calling about your patient Jane Smith, admitted for preterm labor 2 days ago, now experiencing respiratory distress |
| B: Background: explain relevant clinical information | Pt. is a 29 y.o. G2P1 @ 27 wks, started on magnesium sulfate 2 days ago, now at 2gm/hr. Pt received a full dose of Celestone. She has become progressively tachycardic with an HR change from the ’80s to now 110, and O2 sats 88-92% despite supplemental oxygen. Lung sounds are noted to have bilateral crackles and the patient reports mild shortness of breath. She is stable from an obstetric standpoint. |
| A: Assessment: identity what you think is going on with the patient | I’m concerned she is going into pulmonary edema |
| R: Recommendation: identify actions to correct the situation | Can we consider obtaining a STAT chest X-ray, and shutting off her magnesium? The patient also needs an immediate bedside evaluation. Can you come now? |
In this example, SBAR is used to describe immediate concerns related to a patient’s decompensating respiratory status. When SBAR is used in handoffs, it works well if adapted to a specific care area. For example, a laboring patient’s SBAR background could include obstetric history, prenatal labs, and hemoglobin and hematocrit on admission, to name a few.
I-Pass The Baton
I-Pass The Baton was developed by the Agency for Healthcare Research and Quality TeamStepps program as a more comprehensive handoff tool. See the table below for description details.
(Reprinted with permission from AHRQ TeamSTEPPS 2.0 Pocketguide)
I-PASS
This was further refined into I-PASS, developed as a resident handoff tool for inpatient pediatric transitions of care as part of a multisite research project supported by the Initiative for Innovation in Pediatric Education (IIPE), and the Pediatric Research in Inpatient Settings (PRIS) network. It was designed based on resident feedback for complex patients, as a more comprehensive handoff tool for inpatient resident shift reports or patient location changes (Starmer et.al., 2012).
Healthcare is a team sport, requiring effective interdisciplinary collaboration and communication in order to achieve the best possible outcomes for our patients. Using standardized communication tools during handoffs and care transitions is a way to ensure that all the necessary information pertinent to the patient’s care is included and that everyone is doing it the same way every time.
References
Agency for Healthcare Research and Quality (2012). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. TeamSTEPPS Fundamentals Course: Module 3. Communication. Retrieved from https://www.ahrq.gov/teamstepps/instructor/fundamentals/module3/igcommunication.html#ipassbaton
Agency for Healthcare Research and Quality (2013). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. Pocket Guide. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf
Joint Commission Sentinel Event Alert, Issue 58 September 2017
Starmer, A. J., Spector, N. D., Srivastava, R., Allen, A. D., Landrigan, C. P., & Sectish, T. C. (2012). I-PASS, a Mnemonic to Standardize Verbal Handoffs. Pediatrics, 129(2), 201-204. doi:10.1542/peds.2011-2966
Copyright by Jeanette Zocco RNC-OB, C-EFM, C-ONQS