The following are other examples:
SHARED (Situation-History-Assessment-Request-Evaluation-Document) is a system developed at Northwest Community Hospital in Arlington Heights, Illinois, to better meet their individual needs.
ANTIC-ipate (Administrative information: e.g. patient name and location, New information: clinical update, Tasks: preferably in an “if-then” format:, e.g. if hematocrit=X, then transfuse,” Is the patient sick?: an assessment of severity of illness, Contingency planning and code status) is a method and technique developed at the University of San Francisco and the University of Chicago.
Ticket to Ride, a series of questions to be asked of and answered by transporters bringing patients from one department to another, was developed at St. Joseph Health System in Orange, California.
All these techniques and others that are yet to be published are indications that the healthcare community has taken this patient safety goal seriously.
Where does handoff apply? The locations where it commonly takes place are:
Ø Change of shift
Ø Nursing to physician communication
Ø Physician transfer of complete responsibility during vacation coverage
Ø Physician transfer of on-call responsibility
Ø Physician transfer of responsibility to a hospitalist
Ø Nurse temporarily leaving a unit for break
Ø Nurse and physician handoff from patient registration to the inpatient unit (admitting physician to attending physician and admission staff to unit RN)
Ø Physician handoff upon transfer to another hospital setting
The standardized approach to communication promotes clear and direct guidance in providing important clinical information and discourages vague language such as the patient “is crashing,” “going downhill” or “a little unstable.”
Another important application of this method is especially important during planned absences by the medical staff. The use of a hand-off document, either on paper or by email, to the covering physician provides pertinent information about current treatment and condition as well as about any recent or anticipated changes. This process should provide a timeframe sufficient for the receiving physician to review the information and request any additional information if needed. A similar document will also be provided by the covering physician on the return of the physician taking leave. This will be followed by documentation in the physician progress note that this exchange occurred.
As in any new initiatives, there may be barriers to effective implementation of a handoff program. However, these barriers can be overcome by seeking input, listening to concerns, and educating the care providers on the benefits of SBAR+R, i.e. “this technique helps to provide clear and concise information when physicians are called in the middle of the night, and it decreases tension and streamlines work and communication.”
Finally, good design and support for the program, as well as recognition by all team members that this is an important patient safety initiative, will ensure successful implementation.
Resources:
- Joint Commission Resources: Improving handoff communications: Meeting National Patient Safety Goal 2E Patient Safety 6:9-15, Aug. 2006.
- ECRI: Healthcare Risk Analysis, July 2006 Supplement A, Risk and Quality Management Strategies 17. Communication: Healthcare Risk Control System Tools
- CRICO/RMF, FORUM: Reducing Risk During Handoffs. March 2007 Vol 25. No 1
- AORN: Handoff Toolkit
- OR Manager Inc. A SHARED tool Strengthens Handoffs. OR Manager, Vol 22 No.4. April 2006
- Ascension Health Systems: Lourdes Perinatal SBARR Report , 2006, Seton Health Network, SBAR Report
- Greenberg CC, Regenbogen SE, Studdert DM, et.al. J Am Coll Surg 2007; 204: 533-540, Patterns of Communication breakdowns resulting in injury to surgical patients.