Why Your Facility Needs Standardized Nursing Handoffs

Continuity of care is a phrase often thrown about in the healthcare industry. The alliteration and meaning combine for a solid and memorable catchphrase useful for advertising, but its implication for a healthcare facility is much deeper than many outsiders understand. Whether your staff work eight-, 10-, or 12-hour shifts, the implication for patients in your facility is mostly the same—they will receive care from different nurses and clinicians over the course of their stay. Those points of transition—when one clinician is finishing a shift and the next is starting—are critical moments for both patients and facilities. When nursing handoffs are incomplete or inadequate, the consequences can range from medication errors to malpractice and even to preventable deaths.

What Is a Nurse Handoff Report?

The meaning of “handoff” is to transfer the responsibility and information of patient care from one clinician to another. A nursing handoff report is a tool with many different names depending on the work setting. Your facility may refer to it as a shift report, a nurse report, a handover report, a signout, a signover, a nurse-to-nurse report, an end-of-shift report, or simply a nursing report. The purpose of these reports is the transmission of responsibility and important patient information between clinicians. The Joint Commission defines a handoff report as “a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.”

Why Are Handoffs Problematic?

Consider for a moment your own healthcare facility. How many clinicians and allied healthcare personnel are on your clinician roster? How many different units do you have? How many different levels of acuity can your facility provide care for? The spectrum of healthcare delivery is broad, so even if your facility is limited in levels of acuity or skilled units, patient discharges add another point of transfer. In hospitals alone, a five-day stay for a patient averages 15 handoffs between physicians. One hospital reported an estimate of 2 million handoffs per year between nurses. Factors that contribute to problematic handovers include the following:

Factors that contribute to problematic handovers
Rushing through the report
Hierarchy between clinicians during the exchange (does the receiver feel like they can ask questions?)
Different communication styles and personalities
Differences between clinical backgrounds impacting perspective (for example, big picture vs. concise data points)
Distractions and interruptions during the handoff (noise, phone calls, etc.)
Incomplete medical information resulting in errors or omissions
Funneling, defined as “a situation where certain information is missed, forgotten or otherwise not accurately conveyed.”

Standardized Handoff Reports Aren’t Only for Shift Transfers

The importance of standardized handoff reports isn’t limited only to shift changes. In truth, handoffs occur in many other contexts within a facility, such as the following:

Patient transfer to another facility unit (for example, from an Intensive Care Unit to the Progressive Care Unit)
Facility transition (for example, patient discharge from a hospital to a skilled nursing facility)
Between physicians
Between nurses and physicians (hierarchy can present communication issues here)
Between nurses or physicians and specialized clinicians
Patient transfer for diagnostic testing

How to Shore Up Weak Handover Reports

What is the handoff process in your facility? Do you have standard report sheets for nurses? Have you observed how your clinicians handle the transfer of information to the new shift? Whether big or small, your facility can only benefit by focusing on improving these transitions. Research into the issue of compromised handovers repeatedly concludes that facilities would benefit from standardizing the process. (If you remain unconvinced, a quick Google search of the phrase “fumbled handoffs in healthcare” will change your mind.)

There are many different tools or guides your facility can use to standardize the process. For example, mnemonic tools—such as the SBAR, the I-PASS, or ISHAPED—are becoming increasingly popular.

Nurse checking handoff report before shit — Nurse is checking handover report

What Is the SBAR Tool?

The Situation-Background-Assessment-Recommendation (SBAR) tool is a simple framework to structure and guide clinician communication. According to an SBAR implementation and training guide, using the standardized approach of SBAR for handoffs can add value in the following ways:

SBAR removes the potential for ambiguity from these crossover communications. It establishes an equilibrium in communications despite hierarchy or experience, which creates space for confidence in presenting information, professional observations and recommendations, and analyses.
SBAR thwarts the potential for dangerous discrepancies in shared information (oral or written) despite different communication styles. It does this by holding both parties accountable for providing the information the framework itself requires.
SBAR establishes equality among different hierarchical positions by not only acknowledging the importance of the information shared by each party but also requiring them to share it.
SBAR is a short acronym with easy-to-remember steps that helps staff organize their thoughts for clear communication.
SBAR increases the effectiveness with which staff communicate despite perceived barriers thereby making the process quicker overall.

Here’s how the clinician giving the report can follow the SBAR steps:


Situation	Identify yourself and the patient and provide explicit information about the situation.
Background	Provide patient medical history, date and reason for admission, prior procedures, relevant lab and diagnostic results, current medications, and allergies.
Assessment	Flex critical thinking skills at this stage and share professional assessment and concerns.
Recommendation	Provide clear recommendations based on the assessment.

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What Is the I-PASS Tool?

The I-PASS tool—which stands for illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver—was originally published in 2013 with a host of components to aid in its implementation. The curriculum has grown alongside its implementation as over 100 facilities in the US and Canada have integrated I-PASS for handoffs. Here are the basic steps of the I-PASS:


Illness severity	Provide information on the patient’s condition.
Patient summary	Provide patient background and professional assessment.
Action list	Explain what actions need to be taken and who is responsible for those actions.
Situational awareness and contingency plans	Clarify what the current situation is and what the plans moving forward are.
Synthesis by the receiver	The person receiving the handoff summarizes the information shared, reiterates the action list, and asks questions for clarity.

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What Is ISHAPED?

ISHAPED—which stands for introduce, story, history, assessment, plan, error prevention, and dialogue—is a tool that adds a different component to the handoff: patient participation. What sets this structure apart from the others is that it is intended to be completed at the patient's bedside. This is identified as an added safety feature to prevent erroneous information from being transferred or essential information being lost. Furthermore, it aligns well with the growing trend of promoting patient engagement, which leads to better healthcare outcomes. Here are the basic steps of ISHAPED:


Introduce	Introduce the patient, including allergies, status, and clinicians.
Story	Provide the reason for admission, treatment plan, and admission screening results.
History	Provide pertinent medical history, including surgical history and blood administration history.
Assessment	Share data for vital signs, current medications, lab or diagnostic test results, and assessments.
Plan	Identify goals of the plan of care, orders that need to be completed, and patient goals.
Error prevention	Identify any high-alerts and specific medication information.
Dialogue	Engage in dialogue to share concerns, ask questions, clarify the plan, and assign responsibilities.

Where Can I Find a Printable Nursing Shift Report Template?

There are many templates and tools widely available to standardize nursing shift reports. Frameworks vary in style or form, and there is no absolute best practice tool. Nursa does not endorse the use of one tool over another; however, here are a few printable resources about the tools previously summarized:

You can find a guideline and worksheet for the SBAR tool by following this link.
You can find an implementation guideline and resources for I-PASS in the appendices of this published journal.
You can find guidelines and tips for ISHAPED implementation by clicking here.

Effective Shift Reports Can Help Nurses, Too

Standardizing these reports is an effective way to mitigate the risk of gaps of information and errors for your healthcare workers. Furthermore, mitigating gaps and errors will help your facility maintain a continuity of care that boosts the safety of both your patients and your staff. With persistent staffing challenges due to the nursing shortage, pandemic, and subsequent large exodus of nurses from the field, nursing professionals are feeling the strain. When nurses, nursing assistants, and other clinicians feel confident in both giving and receiving reports, they have one less worry to carry. Take it a step further, and fill those shift gaps with qualified per diem nursing professionals by posting your unfilled shifts with Nursa.