Comparative evaluation of the content and structure of communication using two handoff tools: Implications for patient safety

Purpose: Handoffs vary in their structure and content, raising concerns regarding standardization. We conducted a comparative evaluation of the nature and patterns of communication on 2 functionally similar but conceptually different handoff tools: Subjective, Objective, Assessment and Plan, based on a patient problem-based format, and Handoff Intervention Tool (HAND-IT), based on a body system-based format. Method: A nonrandomized pre-post prospective intervention study supported by audio recordings and observations of 82 resident handoffs was conducted in a medical intensive care unit. Qualitative analysis was complemented with exploratory sequential pattern analysis techniques to capture the characteristics and types of communication events (CEs) and breakdowns. Results: Use of HAND-IT led to fewer communication breakdowns (F_1,80 = 45.66: P < .0001), greater number of CEs (t₄₀ = 4.56; P < .001), with more ideal CEs than Subjective, Objective, Assessment and Plan (t₄₀ = 9.27; P < .001). In addition, the use of HAND-IT was characterized by more request-response CE transitions. Conclusion: The HAND-IT's body system-based structure afforded physicians the ability to better organize and comprehend patient information and led to an interactive and streamlined communication, with limited external input. Our results also emphasize the importance of information organization using a medical knowledge hierarchical format for fostering effective communication.