Research Study to Focus on Handoffs of Care in the ICU

“Handoff” is not the friendliest word, yet in healthcare, it has come to define the delicate transfer of information when a patient is discharged from one care setting to another, or when staff members change shifts.  Much has been written about the safety gaps that can occur during these transitions, but this topic is still ripe for research—as Emily Patterson, PhD, well knows.

Emily Patterson, PhD

As principal investigator of a research grant funded by Hospira and awarded through the NPSF Research Grants Program, Patterson and her team are surveying the strategies employed by clinical staff during shift changes in two intensive care units at Ohio State University Medical Center. They are also exploring whether a change of shift influences a change in primary diagnosis and whether a change of leadership makes the staff more or less likely to bring up a safety concern.

Patterson’s project grew out of prior research that seems to indicate positive effects of shift changes. James O’Brien, MD, her co-investigator, recently published a study of intensivists who work a five-days-on and two-days-off schedule—essentially they get a “weekend.” The issue being studied was burnout, not handoffs, Patterson explains. But while burnout was found to be lower among those working the five/two schedule, other factors also may have improved as a result—including mortality.

“Our theory is that handoffs allow a fresh perspective coming onto the case,” she says.  “Critical care is a good place to study this, because everyone needs to act so quickly. There is a rapidly changing treatment plan.”

An industrial and systems engineer, Patterson began studying handoffs in 1994, while working on her master’s thesis at Johnson Space Center in Houston. “At NASA-Johnson they trained people very well,” Patterson says. “There were no written procedures, but everyone did them [handoffs] exactly the same way. “

That said, she admits that “At NASA a change of shift took anywhere from five to 15 minutes. In an ICU, I’ve seen nursing shift changes that took an hour and a half.”

Still, her subjects have so far been keen to participate. “The staff are intellectually curious and more than willing to support it. They like to hear good things,” she says.

One goal of the project is to develop training materials. “We’re really hoping to find a few ideas that can make handoffs safer, at least for the ICU setting,” Patterson says.

Patterson calls it “a real honor” to have received the Hospira grant. “NPSF stands out as a driving force in positive activities in support of patient safety.”

For more information about the NPSF research grants or to read about recent grants, visit our Research Grants Program page.

—Patricia McTiernan