For several years the Joint Commission has had a national patient safety goal emphasizing improvement in handoff communication in patient care settings.

These handoffs take place at the end of nursing shifts, during physician referrals, from surgery to recovery, or ED to inpatient units -- whenever the responsibility for a patient's care is transferred from one set of hands to another.

In health care settings, any one of these transitions can leave room for miscommunication between sender and receiver, and negatively impact patient care.

Specifically in critical care medicine, "you are really on the frontlines, and you see examples of patient care issues that stem directly from poor communication," says J. Gene Chen, MD, MHS, a pediatric critical care fellow at Duke from 2007 to 2010.

For the research component of his fellowship, Chen sought to study communication at the point of postoperative handoff, an especially sensitive time for children following cardiac surgery.

Utilizing situation awareness, a way to objectively measure recipient understanding, Chen and fellow physicians hypothesized that a structured approach to handoff communication would improve the receiver’s awareness of the patient’s situation, laying the foundation for better care while under their supervision.

In June 2008 they designed an experimental simulation-based study to evaluate:

1. The effect of communication methods on situation awareness
2. Medical simulation as a tool to study handoffs

During the testing phase, 33 PICU (pediatric intensive care unit) team members -- including physicians, registered nurses, respiratory therapists, and nurse practitioners -- participated in in situ simulations of cardiac surgery handoffs and completed multiple-choice assessments of two domains of situation awareness.

"The first domain was perception, on things like the patient's weight, blood pressure, and the medical procedure," says Chen. "The second domain was comprehension, the overall synthesis of the facts. For example, why does the patient have low blood pressure?"

The mean score on the assessments was 60 percent. The structured communication method improved simple recall scores by 9 percent, but did not impact the participant's ability to anticipate the postoperative course.

Although subjects were blinded to the intervention, the majority thought structured handoffs demonstrated better communication. Most participants believed the simulation was realistic, and all agreed that the experience would improve actual patient handoffs.

Of particular note, after a postoperative handoff, situation awareness in handoff recipients was low overall. Chen's study provided insight into ways to improve handoffs, such as having the communicator offer a summary and expected path for the patient to help the receiver synthesize the details. The study results were submitted to the journal Critical Care Medicine, with editorial review to be completed by this fall.

The handoff research team includes J. Gene Chen, MD, MHS; David A. Turner, MD; Melanie C. Wright, PhD; Richard J. Ing, MB BCh; Andrew J. Lodge, MD; James Jaggers, MD; P. Brian Smith, MD, MHS, and Kshitij P. Mistry, MD, MSc.