Improving hand-off communications: new solutions for nurses.

LAPSES in complete, accurate communication between caregivers when responsibility for patients is transferred or “handed off”are a major issue affecting the quality and safety of patient care. Although the primary objective of a hand-off during a transition of care is to provide accurate information about a patient’s care, current condition, and any recent or anticipated changes, unfortunately each hand-off can present unique opportunities for error. One study estimates that 80% of serious medical errors involve miscommunication between caregivers during such transitions in care.1 Communication breakdowns during transitions of care were a leading cause of sentinel events reported to The Joint Commission between 1995 and 2006.2 Health care organizations have long struggled with the process of passing necessary and critical information about a patient from one caregiver to the next or from one team of caregivers to another. A hand-off involves “senders,” the caregivers transmitting patient information and releasing the care of the patient to other providers, and “receivers,”