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Holistic strategy for promoting effective handoffs
  1. Joseph Roland Keebler1,
  2. Elizabeth Lazzara1,
  3. Andrew Griggs1,
  4. Scott Tannenbaum2,
  5. Rosemarie Fernandez3,
  6. Philip Greilich4,
  7. Eduardo Salas5
  1. 1 Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA
  2. 2 The Group for Organizational Effectiveness, Albany, New York, USA
  3. 3 Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  4. 4 Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA
  5. 5 Department of Psychological Sciences, Rice University, Houston, Texas, USA
  1. Correspondence to Dr Joseph Roland Keebler, Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA; joekeebler{at}


Background Handoffs are ubiquitous in modern healthcare practice, and they can be a point of resilience and care continuity. However, they are prone to a variety of issues. Handoffs are linked to 80% of serious medical errors and are implicated in one of three malpractice suits. Furthermore, poorly performed handoffs can lead to information loss, duplication of efforts, diagnosis changes and increased mortality.

Methods This article proposes a holistic approach for healthcare organisations to achieve effective handoffs within their units and departments.

Results We examine the organisational considerations (ie, the facets controlled by higher-level leadership) and local drivers (ie, the aspects controlled by the individuals working in the units and providing patient care).

Conclusion We propose advice for leaders to best enact the processes and cultural change necessary to see positive outcomes associated with handoffs and care transitions within their units and hospitals.

  • strategy
  • communication
  • improvement
  • organisational effectiveness
  • standardisation

Data availability statement

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  • Contributors All author’s contributed substantively throughout the writing of this paper. The idea was originated among JRK, EL, ST and ES. We then brought on RF and PG as our medical counterparts to refine and ground the ideas. AG helped substantively with literature review and iterative drafts of the manuscript. RF also provided vignettes throughout the manuscript. All authors wrote a portion of the manuscript and worked on multiple edits and iterations to achieve the final version presented here.

  • Funding This work was partially supported by the Center for Clinical and Translational Sciences (University of Texas Health Science Center, Houston, Texas, USA), which is funded by the National Institutes of Health (Clinical and Translational Award UL1 TR003167) from the National Center for Advancing Translational Sciences. Rice University is a partner on this grant. This work was also partially funded by the University of Texas Southwestern Office of Medical TeamFIRST Quality Enhancement Plan (no award grant number).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.