Achieving "Safe Handoffs"

As one strategy to increase the quality of home healthcare, members of the Home Healthcare Collaborative (HHC) are participating in a quality initiative focused on increasing effective communication with other parts of the healthcare delivery system. The Collaborative has identified safe handoff’s as the key place for reducing unnecessary risk to patient during transitions.

Communication breakdown is the leading cause of avoidable error in healthcare. When care is transitioned from one individual to another, and from one care setting to another, there is significant quality and safety risk involved.  As home health care providers look forward to developing partnerships, ACO’s and transitions of care communities in Colorado, creating tools to reduce human error is essential. 

The HHC has recommended the use of checklists.  This has been identified as best practice for consistency, reducing human error and for the improvement of recall leading to improved patient outcomes.  Checklists and acronyms related to handoffs can be found in the literature focusing on communication between like agencies or like providers.  Yet there is no evidence of a history of handoff recommendations between care settings, where there is a great risk for error.

The evidence from the Agency for Healthcare Research and Quality[1] indicate many healthcare providers have never practiced in the settings where the patient is being transferred.  This lack of experience, knowledge and critical appreciation of the capabilities of care provided across the continuum of care can potentially have an impact on the safety and quality of the transition of care and may lead to unnecessary readmissions.

Using a checklist during transitions of care can help ensure all components of the handoff are complete.   In an effort to reduce the risk related to human error and improve the communication between care settings, the HHC developed a unique set of tools for providers to use when patients transition in and out of home health care. These tools can readily be adapted for use in other settings.  It is our goal that all care agencies that either admit to or receive patients from a home healthcare agency in Colorado use these tools to ensure every patient transition is a safe one!   The tools can be adapted with a company logo for ease in communication.   For a copy of the white paper related to our quality project and a copy of the checklist tools, contact the Center.

[1] Agency for Healthcare Research and Quality - AHRQ – www.ahrq.gov Safe Handoffs and Transitions of Care