White Paper: Improving Handoff Culture in Intensive Care Unit to Floor Handoffs

The frequency of handoffs between providers has increased since the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions, generating concerns over the quality of these handoffs and their impact on patient safety. At Thomas Jefferson University Hospital (TJUH), the 2016 Safety Culture Survey revealed that across all specialties, many residents felt that “things fall through the cracks” when transferring patients from one unit to another. The interdepartmental Housestaff Quality and Safety Leadership Council (HQSLC) at TJUH sought to improve handoffs at our institution and identified two areas of focus: (1) standardizing the language of handoffs with a commonly accepted handoff technique (IPASS), and (2) standardizing the process of handoffs from the ICU to the floor. Qualitatively, resident comfort with handoffs improved with no adverse impact on time to patient movement between units. This project demonstrated the difficulty of changing the handoff culture at an institution, establishing lasting change via a new EMR system, and training housestaff of a new handoff method. Future directions include monitoring compliance with the new standardized handof f curriculum, and determining whether these efforts and interventions translate to improved patient safety at our institution