To design and implement a restructured handoff system and EMR tool and to assess for its efficacy.

Handoff is a pivotal part of inpatient medical care. It can enhance the physician and patient experience, and at the same time lead to medical errors and poor communication. In the era of ever-changing duty hours, quality handoff becomes even more important.  Studies have shown both the benefits and pitfalls of limited resident work hours, and with them the increasing number of handoffs.   Increasing attention has been paid to the handoff process and ensuring consistent and quality information.

The contemporary handoff procedure was evaluated in terms of its content and technological interface. Neurology residents were surveyed based on the efficacy and quality of the handoff process.  The restructured handoff was then implemented, which included educating residents on the information to be communicated, as well as implementation of a simplified EMR handoff tool.

The data showed overall that residents felt they spent a more appropriate amount of time on handoff, that handoff was more well organized, and more efficient.  Overnight residents stated they felt more prepared for nighttime coverage, more consistently given a one-liner for each patient, and that overnight events were more consistently passed on to the day team.  Although residents do feel that there was a decrease in miscommunications, they did not feel that there was a change in adverse events because of a poor handoff.

Handoff is a central function of the medical team that increases in importance with stricter duty hours, and has both an impact on the physician experience and patient care. The data collected above show that performing this process with a priority on standardizing handoff information and providing a usable technological workflow has the ability to improve the handoff process and ultimately patient care.