Title: Best Practices within Handoff Communication for Pediatric Populations

Abstract

Background/Introduction:

Handoff communication is a vital aspect of medical practice. Communication increases continuity of care between providers, decreases medical errors, and increases the quality of patient care. The Children’s Hospital of Colorado (CHCO) has been researching ways to increase

patient safety, increase efficiency, and decrease medical errors surrounding handoff communication. Regis Honors students in collaboration with CHCO conducted an Evidence-Based Practice Project (EBP). The focus of this project was to further knowledge of best practices and offer alternatives for handoff communication within pediatric hospitals.

Purpose:

With the guidance of the following PICO questions:

- Within pediatric hospitals, how does using alternative hand-off communication tools, such as Flex 11 and ISHAPED compared to using the SBAR hand-off communication tool affect the effectiveness and efficiency of handoff reports? - In the pediatric clinical setting, how does physician handoff report using I-PASS compared with nursing handoff report using SBAR affect patient safety and communication to foster continuity of care? - In the pediatric clinical setting, how does nurse-to-nurse handoffs at the nursing station compared to nursing handoffs at bedside affect report handoff within shift change?

Learner Outcome/Objectives:

The learner will compare and contrast 3 methods for handoff report in pediatric settings that are evidence based.

Methods:

Literature search identifying key terms: “Handoff communication,” “Patient handoff,” Pediatric hospitals,” “Physician handoff,” “Flex 11,” “Handoff tools, pediatric,” “SBAR,” “IPASS,” “ISHAPED,” and “Transfer of care.” The databases used for research were CINAHL, PubMed, Cochrane, and MEDLINE. Articles were excluded if they were not surrounding pediatrics, if they were not published in the last 5 years, and if they did not discuss specific handoff tools. Sixteen articles were selected for this project.

Results:

Three alternative handoff tools: Flex 11, ISHAPED, and m-ISHAPED were identified as effective handoff tools to decrease medical errors, increase nursing satisfaction, increase

efficiency, and increase patient satisfaction. Performing handoff at beside allowed for the opportunity to incorporate more updated information on the patient, thus making report more efficient and structured. Important limitations to acknowledge were small sample sizes, lack of sufficient evidence, and simulated environments. Key findings included the consistency of evidence that a systematic handoff report tool is more effective than not using one. There is consistent evidence that supports that SBAR and I-PASS increases preparation for use by nurses and physicians, respectively. With structured outlines for SBAR and I-PASS, there is reduced risk for medical errors when it comes to report handoff.

Conclusions/Implications for Practice:

The recommendation to Children’s Hospital of Colorado is to continue using SBAR and I-PASS for handoff communication and to consider conducting further research within the hospital on the identified handoff alternatives. The continuation of handoff report at the bedside better implements updated information on the patient. While the alternatives might prove to be effective with further research, there is not enough research in the inpatient settings to justify their use and potential risk for patient safety.