Researchers Reaffirm Link between Effective Nurse Communication, Patient Safety

A systematic review of nursing handoff literature has determined that minimal research has been done to identify best practices, despite well-known negative consequences of inadequate nursing handoffs. The article was published in the April issue of the American Journal of Nursing (AJN).

"Nursing handoffs occur when shifts change two or three times daily, seven days a week, yet despite the frequency of these events, there are few evidence-based standardized procedures to ensure that communication is managed effectively," said Lee Ann Riesenberg, director of Medical Education Research and Outcomes, Academic Affairs, Christiana Care Health System, Newark, Delaware and research assistant professor, Jefferson School of Population Health, Thomas Jefferson University. "Errors in communication give rise to substantial clinical morbidity and mortality and, therefore, must be addressed."

In 2005, the Joint Commission found, after reviewing a decade's worth of data, that "breakdowns in communication" were implicated in two-thirds of all types of sentinel events. Furthermore, a 2009 Agency for Healthcare Research and Quality survey found that almost half (49 percent) of hospital staff respondents reported that important patient care information is lost during shift changes.

"This study underscores the need for more research in this area," said Maureen Shawn Kennedy, MA, RN, editorial director and interim editor-in-chief of AJN. "Even though the Joint Commission is now requiring the standardization of patient handoffs, there's little evidence to indicate how to most effectively accomplish this process."

A systematic review of articles, published between Jan. 1, 1987 and Aug. 4, 2008, identified all articles about nursing handoffs in the United States. The authors conducted a systematic review of research studies and a qualitative review of barriers to, and strategies for, effective handoffs.

The study notes that there are risks involved in implementing interventions for which evidence of effectiveness is lacking and calls for high-quality outcomes studies. While standardized handoff reporting makes intuitive sense and may yield greater accuracy, increase patient and nurses' satisfaction and save nurses time, evidence is needed to identify the best structured protocols and interventions. It also was noted that no one format will suffice across all departments or facilities; therefore, handoff elements will have to be adapted for different nursing areas.

The qualitative analysis identified barriers in several major categories. Of these categories, communication barriers were most frequently noted, including lapses in communication or failures to communicate, lengthy or irrelevant content, inaccurate recall of communicated information, illegible handwriting and poor communication between nurses and physicians. Other barriers included lack of supportive behaviors among nurses and poor peer relationships, problems associated with standardization of tools and systems, and environmental issues (poor lighting, distractions).

Strategies included increased standardization for communicating, including technology (use of computerized handoff systems), tailoring report tools to specific departments, and ensuring recognition that a transfer of responsibility had occurred.

Strategies also included addressing environmental problems such as poor lighting and excessive noise, providing training or education, more staff involvement in the development of training programs, allowing adequate time to plan for a new handoff process as well linking the handoff process to performance evaluation.

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