Effect of Patient Handoffs on Nursing Self-Efficacy

Perioperative services at Barnes-Jewish Hospital assumed the task of determining how to improve patient handoff processes within the hospital. Defined methods of handoff were formulated by several teams within the perioperative department. Education of all perioperative staff was done with the new handoff processes in late 2017. Elimination of written PACU to floor nursing reports was attempted by reliance on more telephone to floor handoffs. A reference guide was developed at Barnes-Jewish Hospital to serve as a tool for handoffs. Patient handoffs are considered high risk, error-prone, and potentially rife with technical and communication errors, especially within chaotic and complex environments such as intensive care units. Correlations were found between patient outcomes and handoffs (Segall et al., 2012). Poor communication during handoffs can prolong patient recovery time, precipitate dangerous complications, create omissions in care, and lead to patient, family, and nursing staff dissatisfaction (Dufault et al., 2010).

A responsibility of the PACU nurse is to provide a method of handoff to the receiving nurse upon transfer. The Joint Commission Center for Transforming Healthcare has defined the patient handoff as a real-time transfer and acceptance of information from one caregiver to another (Taylor, 2015). During the handoff transition phase from the PACU to the floor, communication is an essential component of safe, adequate care. Lack of research-based standards for handoff protocols and policies was identified. The National Quality Forum recommended that handoffs consist of a standardized approach, be timely, and understood (Dufault et al., 2010). The Joint Commission has considered this issue to be a public health policy issue (Dufault et al., 2010). National Patient Safety Goals (NPSG) stated that handoffs in care should afford staff an opportunity to ask and respond to questions. Based on the variances in the three methods of handoffs used by the PACU, the handoff practices failed to meet the consistency criteria outlined by the National Quality Forum and the ability to ask and respond to questions as recommended by the NPSG when nurses used the written handoff method. Avoidance of the written handoff was suggested unless nursing staff could not reach the receiving nurse after multiple telephone attempts.