Improving Information Transfer, Shared Understanding, and Working Atmosphere Between Intrahospital Settings with Standardized Handoff Checklist

Background. Following the publications of “To Err is Human: Building a Safer Health System” in 1999, by the Institute of Medicine, and the National Patient Safety Goal 2E by the Joint Commission in 2006, the standardization of communication in the healthcare setting was deemed a national priority. While research regarding nursing handoff is prevalent, the lack of reliable instruments for nursing handoff between the ED and MICU continues to be problematic.

Purpose. To evaluate whether a standardized handoff checklist improved information transfer, shared understanding, and working atmosphere between nurses in the ED and the MICU in a quaternary, academic center over a four-week time period.

Design. This project used pre and post comparison.

Methods. The Manser Survey was used pre-intervention to determine baseline perceptions of handoff between nurses in the ED and MICU. An equal number of nurses from both units then participated in a focus-group intervention, utilizing the I PASS the BATON handoff instrument, for the creation of the ED/MICU Handoff Checklist, based on the individual needs of their unit environment and patient population. The Manser Survey was repeated post-intervention to assess for changes following the implementation of the standardized ED/MICU Handoff Checklist.

Results. Findings from the matched data report statistically significant improvement in all three factors of the Manser Survey (information transfer, shared understanding, and working atmosphere), following implementation of the ED/MICU Handoff Checklist (p < 0.05).

Conclusion. The improvement in perception of handoff following the implementation of the ED/MICU Handoff Checklist speaks to the significance of standardization in handoff between these two populations and the importance of understanding unit cultural variations and its effect on the handoff process.