Carroll, J.S., Williams, M. & Gallivan, T.M. (2012). The ins and outs of change of shift handoffs between nurses: A communication challenge. BMJ Qual Saf (2012). doi:10.1136/bmjqs-2011-000614

Shift handoffs can be used as benchmarks to assess quality of communications among healthcare staff. Because communication overall is critical to quality of care, it is important to understand the factors that can improve shift handoff efficiency. Shift handoffs involve both technical communication and relational communication. Technical communication refers to the transfer of specific and relevant patient data. Relational communication refers to softer psychological and affective information including the conveyance of trust and respect. This study encompasses multiple methodologies to assess shift change efficacy in terms of both technical and relational communication. Interviews, surveys, and clinical records were all used as sources of data. The authors found variability in terms of nurse expectations during shift handoffs. Shift handoff behaviors varied according to level of experience and the role of the healthcare provider. Suggestions for improving the efficiency and quality of handoffs include standardizing the procedure and streamlining communications between incoming and outgoing staff.

Research/Study: The researchers use multiple methods, both qualitative and quantitative, to evaluate the research questions. The research design is not experimental, but does use observational and descriptive methods. Two different medical units were observed. Surveys and interviews with staff were collected for background information, and then dependent variables were measured using audio tape, direct observation with detailed field notes, posthandoff questionnaires, and coding of nurse records. Using a multimodal design enhanced the validity and reliability of the research.

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Methods: 28 nurses consented to participate in the research. Participants agreed to wear recording devices, and the researchers supplemented the recording devices with visual observations of nonverbal communications between incoming and outgoing nurses. All handoff records were analyzed systematically by RNs. Additionally, data was collected via a one-page posthandoff questionnaire.

Setting/Subject: The primary setting was two different medical/surgical units in a large urban teaching hospital. These units were chosen because patients required high levels of nursing care. A total of 28 nurses offered their consent to participate but only 23 were actually observed fully.

Findings/Results: Handoff procedures varied considerably across units, among different nurses, and particularly based on experience level of the nurses. Average handoff length of time was 5.4 minutes per patient. Whereas outgoing nurses talked the most, 80% of all questions were asked by the incoming staff. Self-assessed handoff efficacy versus expert coded handoff efficacy varied. In other words, nurses believed their handoffs were more effective than they actually were based on the objective data analyses. Key correlates with handoff effectiveness included relational communication variables, which were more highly regarded than the technical communication variables. Incoming nurse familiarity with the patients understandably improved effectiveness of the handoff. The fewer questions the incoming nurse had for the outgoing nurse, the more highly rated was the handoff. Incoming nurses tended to prefer standard nonverbal communication signals including eye contact; outgoing nurses were eager to leave and preferred quicker handoffs with less eye contact and fewer questions.

Variables: This was not an experimental research design. Independent variables included the raw data related to the handoffs including the status and role of the nurses and whether the nurses were incoming or outgoing. Dependent variables included both the self-reports of the handoffs and also the transcript/observation analyses. Specific variables included self-report measures of handoff effectiveness and also the analysis of verbal and nonverbal communication data.

Implication for Practice: This research offers tremendous insight into how nurses can improve patient handoffs and therefore promote more effective communications overall. Unfortunately, what constitutes an effective handoff is difficult to quantify. The features of an effective handoff will vary depending on any number…


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