Nursing Handoffs: A Systematic Review of the Literature

Objective: Handoffs of patient care from one nurse to another are an integral part of nursing practice; but there is abundant evidence that poor communication and variable procedures result in inadequate handoffs. We sought to conduct a systematic review of articles that focused on nursing handoffs, conduct a qualitative review of barriers to and strategies for effective hand-offs, and identify features of structured handoffs that have been effective. Methods: We conducted a systematic review of English-language articles, published between January 1, 1987, and August 4, 2008, that focused on nursing handoffs in the United States. The search strategy yielded 2,649 articles. After title review, 460 of these were obtained for further review by trained abstractors. Results: Ninety-five articles met the inclusion criteria; of these, 55 (58%) were published between January 1, 2006 and August 4, 2008. Content analysis yielded identification of barriers to effective handoffs in eight major categories and strategies for effective handoffs in seven major categories. Twenty articles involved research on nursing handoffs. Quality assessment scores for the research studies ranged from 2 to 12 (possible range, 1 to 16). The majority of the research studies on nursing handoffs (17 studies; 85%) received quality scores at or below 8 and only three achieved scores above 10. Ten (50%) of the studies included measures of handoff effectiveness. Conclusion: Despite the well-known negative consequences of inadequate nursing handoffs, very little research has been done to identify best practices. There is remarkable consistency in the anecdotally suggested strategies; but there is a paucity of evidence to support them. We call for high-quality studies of handoff outcomes that focus on systems factors, human performance, and the effectiveness of structured protocols and interventions.