Elevate Patient Safety with Structured Hand-Off Protocols

A Closer Look at New Updates to the Guideline for Team Communication

Structured Hand-Off Protocols

Effective communication is essential to safe patient hand-offs. The updated guideline includes a revised recommendation that calls for staff training on hand-off protocols. Training based on best practices teaches team members to communicate effectively. It also helps to establish clear roles and ensures staff engagement.

Lisa Spruce DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN

Lisa Spruce, coauthor of the updated guideline, serves as AORN’s senior director of Evidence-Based Perioperative Practice. Spruce explains that when managing protocols and processes, it’s important to have infrastructure in place that promotes standardized patient care and includes feedback mechanisms.

To reinforce this point, a new recommendation calls for teams to use a structured framework for creating and maintaining a hand-off process.

Examples of a structured framework include change theory and quality improvement processes.

Importance of a Customized Structured Hand-off Process

The guideline offers new insight on what to include in a customized structured hand-off process. This process includes strategies to help identify and mitigate patient safety risks. It also helps to ensure everyone is on the same page during a hand-off.

“It’s important for everyone involved in a hand-off to be fully engaged. We want to individualize hand-offs specific to the patient population and their level of acuity,” says Spruce. “Every facility should be customizing their hand-off process. That makes it meaningful to them and their patients.”

Elements of an Effective Structured Hand-off Process

• Allow time to complete all components of the hand off
• Communicate clearly
• Be willing to collaborate with all team members
• Recognize the value of the other person’s information
• Summare important information to ensure mutual understanding

Improving Quality of Information Exchanged at Hand-off

To reduce communication failures, new guidance suggests implementing the following as part of a standardized hand-off process:

• Standardized tools
• Protocols
• Mnemonics
• Checklists

Additionally, when creating or modifying these items, incorporate evidence-based recommendations. Also, key stakeholders should be part of the process. Be sure to refer to existing hand-off tools and use the electronic health record to generate patient data and risk reports.

Standardized Process: Hand-offs from OR to ICU

The hand-off of a patient from the OR to the intensive care unit is a complex process. As Spruce notes, these patients are high acuity and have an increased risk of adverse events because of the potential for inadequate information transfer.

• New recommendation: create a standardized hand-off process for patients transferred from the OR to the intensive care unit.

“We gave additional guidance on how to structure this process and outlined the barriers to standardization, such as time pressure, unclear expectations, and confusion around what each clinician needs in a hand-off process,” Spruce says. “It’s important to incorporate clinician perspectives into a standardized hand-off process, with future studies focusing on if that aspect impacts patient outcomes.”

Elements to Include in Hand-offs

• Flexible, but standardized information
• Customized checklists
• Time for questions
• Tool that encourages shared understanding and common goals and care plans
• Processes that support the entire hand-off process
• Tools that work with the electronic health record to auto-populate and update information
• Routine training and implementation

» Read More: The updated guideline also recommends developing a culture of safety that integrates team training, use of standardized safety checklists, and implementing systems that promote resilience in systems and individuals in the periop setting.

View Guideline Details

This updated guideline is available in AORN eGuidelines Plus (available to subscribers). 

» Members log in for Guideline Essentials for Key Takeaways, implementation tools, and more.

eGuidelines Plus is an online library of clinical resources for your facility. It provides your team and multiple service lines at your facility with digital access to evidence-based guidelines, customizable implementation tools, and time-saving clinical resources.

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