Evidence table of primary studies included
| Author reference/study design/country | Handoff tool Handoff from whom to whom | Co-interventions and implementation activities | Setting/context | Sample size | Clinical outcomes |
| Starmer et al35/ pre–post/USA | I-PASS precursor study, which used SIGNOUT Physician-to-physician | Two-hour communication training session Restructuring of verbal handoffs into a single team handoff Computerised tool at one site | General inpatient paediatric units One hospital Academic | 1255 patient admissions | Medical errors per 100 admissions Pre: 33.8, post: 18.3 Preventable adverse events per 100 admissions Pre: 3.3, post: 1.5 |
| Starmer et al37/ pre–post/USA | I-PASS Physician-to-physician | Two-hour workshop One-hour role playing and simulation Faculty development programme Process and culture change | General inpatient paediatric units Nine hospitals Academic | 10 740 patient admissions | Medical errors per 100 admissions Pre: 24.5, post: 18.8 Preventable adverse events per 100 admissions Pre: 4.7, post: 3.3 |
| Starmer et al36/ pre–post/USA | I-PASS Physician-to-physician | Eight key areas for implementation, which include establishing team structure, conducting a needs assessment, training, use of clinical champions and feedback | Various inpatient units, both paediatric and adult 32 hospitals (20 academic, 12 community) | For clinical outcomes, the sample size is not stated | Across sites, the rate of handoff-related adverse events per person-year (as reported by a physician survey, response rate=59%) Pre: 1.7, post: 0.9 |
| Dewar et al28/ pre–post/USA | I-PASS modified Physician-to-physician | I-PASS modified to work on EHR No interruption rule during handoff Two learning sessions Faculty observation | General medicine service staffed by family medicine trainees One hospital Community tertiary care teaching hospital | 1290 patient admissions | Medical errors reported to the EHR online error reporting system, per 100 admissions Pre: 6.0, post: 2.2 Preventable medical errors per 100 admissions Pre: 0.65, post: 0.15 |
| Goldraij et al29/ pre–post/Argentina | I-PASS Physician-to-physician | Educational module Two PDSA (Plan-Do-Study-Act) cycles focused on different aspects of implementation | Specialist palliative care programme within a large university hospital One Academic hospital | 13 hospice patients | Positive reports by family members of patient comfort: PDSA #1: 63%, PDSA #2: 87% Staff doing enough to keep the patient comfortable: PDSA #1:75%, PDSA #2: 100% |
| Jorro-Barón et al30/ RCT/Argentina | I-PASS Physician-to-physician | Local adaptation based on local barriers and facilitators Two-hour workshop Teamwork training role-play Self-learning module Faculty development programme Observation of handoff by faculty | Six paediatric ICUs Five hospitals Academic status not stated but likely | 1465 patients | Rate of preventable adverse events per 1000 hospital days: Intervention: 60.4, control: 60.4 Total adverse events per 1000 hospital days: Intervention: 93.7, control: 86.0 Preventable AE with patient death: Intervention: 5 events, control: 3 events HAI per 1000 hospital days: Intervention: 19, control 20.9 |
| Khan et al,31 Kuzma et al32/ pre–post/USA | I-PASS modified Physician-to-physician Physician-to-nurse | I-PASS modified to be ‘Patient and Family Centred I-PASS’ Includes:
| General inpatient paediatric wards Seven hospitals Mostly or entirely academic | 3106 patient admissions | Medical error rate per 1000 patient days Pre: 41.2, post: 35.8 Harmful errors per 1000 patient days Pre: 20.7, post: 12.9 Non-preventable adverse events per 1000 patient days Pre: 12.6, post: 5.2 |
| Parent et al33/ RCT/USA | I-PASS modified Physician or NP/PA-to-physician or NP/PA | ICU adaptation of the I-PASS tool Modified to work on EHR Weekly reinforcement with audio-visual presentations and faculty observation of handoff | Eight adult ICUs Two hospitals Academic | 4153 patient-days | ICU LOS Intervention: 7.3 days, control: 7.5 days Duration of mechanical ventilation Intervention: 3.5 days, control: 4.3 days Reintubations within 24 hours Intervention: 1.2%, control: 1.5% |
| Sonoda et al34/ pre–post/USA | I-PASS Physician-to-physician | Didactic lecture On-the-job training | Family medicine inpatient service One academic hospital | 29 Family medicine residents, # of patients NS | Total number of medical errors using the institution incidence/occurrence system Pre: 6, post: 10 |
| Stenquist et al38/ pre–post/USA | I-PASS modified Physician-to-physician | Modification of I-PASS for use in orthopaedics, called OrthoPass Adapted to use on the EHR | Two level 1 trauma centres Two hospitals Academic | 1984 patients | ‘No statistically significant differences were observed between rates of 30-day readmission, 90-day readmission, UTI, pulmonary embolism/DVT, surgical site infection or delirium’ |
| Ting et al40/ pre–post/Taiwan | SBAR Nurse-to- physician | One-hour training session | Obstetric ward One hospital Teaching status not stated | 7243 neonates | 5 min APGAR scores less than 7: Pre: 4.3%, post 1: 4.5%, post 2: 5.0% |
| Tam et al39/ RCT/Canada | iHAND and SIGNOUT Physician-to-physician | 45 min training and education session Role-playing exercise | Internal medicine inpatient wards staffed by nine inpatient medical teams One hospital Academic | 1168 patients | All medical errors Intervention: 4.8%, control: 4.1% Preventable adverse events Intervention: 0.8%, control: 1.5% In-hospital mortality rate Intervention: 10.9%, control: 11.7% Proportion of patients transferred to ICU Intervention: 1.9%, control: 1.6% |
| Verholen et al41/ RCT/Germany | ISBAR3 Physician-to-physician | Adapted to use in tablet (iPad mini) | Seven ICU wards One hospital Academic | 1038 patients | 30-day mortality: mean difference between intervention and control: 1.59% Length of stay: mean difference between intervention and control: 5.26 days Reuptake rate within 30 days: mean difference between intervention and control: 7.03% |
AE, adverse event; APGAR, Appearance, Pulse, Grimace, Activity and Respiration; DVT, deep vein thrombosis; EHR, electronic health record; HAI, hospital-associated infection; ICU, intensive care unit; I-PASS, Illness severity, Patient Summary, Action list, Situation awareness and contingency plans, and Synthesis and 'read back' of the information; ISBAR3, Identification, Situation, Background, Assessment, Recommendation, Read-back, Risk; LOS, length of stay; NP, nurse practitioner; NS, not stated; PA, physician assistant; RCT, randomised controlled trial; SBAR, Situation, Background, Assessment, Recommendation; SIGNOUT?, Sick or DNR?, Identifying data, General hospital course, New events of day, Overall health status, Upcoming possibilities with plan, Tasks to complete overnight with plan, ? Any questions; UTI, urinary tract infection.