College of Arts & Sciences Research

This meta-analysis attempts to understand the benefits of a structured communication process on patient, provider, and organizational outcomes. Studies have found that one of the most crucial points during a patient’s hospital stay is the transition of care between one or more providers, often referred to as a patient handoff. These brief interactions between providers are often especially vulnerable to communication breakdowns due to interruptions, omission of pertinent information by the sender or receiver of the information. To illustrate, upwards of 80% of severe, preventable medical errors have been attributed to miscommunication during handoffs. In other words, failures in communication during handoff are potentially responsible for the loss of hundreds of thousands of lives every year in the United States.

Standardized protocols – usually in the form of a short mnemonic (e.g. SBAR – situation, background, assessment, recommendation) or a longer multi-item checklist - have been required by the Joint Commission, but meta-analytic integration of handoff protocol research has not been conducted. Meta-analysis is a statistical technique that quantitatively assesses effects across multiple studies, providing a summary of the current state of the science. The overall purpose of this study was to understand the effects of handoff protocols using meta-analytic approaches. Handoff information passed during transitions of care, patient outcomes, provider outcomes, and organizational outcomes are the primary outcomes studied for this research.

Initially 4,556 articles were identified across a multitude of literature databases, with 4,520 removed. This process left a final set of 36 articles, all which included pre-/postintervention designs implemented in live clinical/hospital settings. Meta-analyses were conducted on 34,527 pre- and 30,072 postintervention data points.

Results indicate positive effects on all four outcomes: handoff information, patient outcomes, provider outcomes, and organizational outcomes. We found protocols to be effective, but there is significant publication bias and heterogeneity in the literature. Publication bias indicates that only studies with significant findings are being published, while heterogeneity indicates that studies are not being conducted the same way – usually lacking standardized metrics. These results demonstrate that handoff protocols tend to improve results on multiple levels, including handoff information passed and patient, provider, and organizational outcomes. Significant effects were found for protocols across provider types, regardless of expertise or area of clinical focus. It also appears that more thorough protocols lead to more information being passed, especially when those protocols consist of 12 or more items. This research has continued to this day, with a recent dissertation (Kristen Welsh-Webster) completed i in 2017 on implementation of handoffs in a live anesthesia unit. Keebler and Lazzara’s team are currently writing multiple grants in collaboration with local and national hospital systems to improve their handoffs and team processes surrounding care transitions.