1. Erin Long BSN, RN, DNP Student
Hello and thank you all for coming. I am excited to tell you about my Evidence-Based Practice project and show you what I have dedicated the last year to accomplishing. My project is entitled: Operating Room Nurse to Post Anesthesia Care Unit Nurse Handoff, Implementation of a Wrtitten SBAR Intervention.
Operating Room Nurse to Post Anesthesia Care Unit Nurse Handoff: Implementation of a Written SBAR Intervention
Erin Long BSN, RN, DNP Student

2. Acknowledgements Dr. Kessler Perioperative Nurses Family Classmates
I would like to thank Dr. Kessler for her continual support and guidance throughout the development and implementation of this EBP project. Also many thanks to the perioperative nurses who graciously agreed to participate.
I would like to dedicate this project to my family and thank them for their patience with me throughout the many stresses and successes of this DNP program. Thank you for your endless love, support, and encouragement.
And also to my classmates, with whom I have been blessed to share this journey and for whom I have great respect.
Dr. Kessler
Perioperative Nurses
Family
Classmates

3. PICOT Question
This EBP project aimed to answer the PICOT question: In perioperative nurses, how will the implementation of a written SBAR Handoff Form affect the content of handoffs between OR and PACU nurses and impact the perceptions of teamwork and patient safety of perioperative nurses over the course of three months when compared to current oral report practice?
In perioperative nurses, how will the implementation of a written SBAR Handoff Form affect the content of handoffs between OR and PACU nurses and impact the perceptions of teamwork and patient safety of perioperative nurses over the course of three months when compared to current oral report practice?

4. Significance of the Background
The unique setting of the perioperative area is subject to particular barriers to communication including noise, interruptions, and a high rate of patient arrival and discharge. The operating room, or OR, nurse must handoff in a timely manner in order to maintain a busy operative schedule while the Post Anesthesia Care Unit, or PACU, nurse must care for several patients in need of various levels of care.
A lack of structure to the handoff between these nurses places surgical patients’ safety at risk as miscommunication is more common when handoff protocol is not standardized. In fact the Joint Commission has completed studies showing that 50%-70% of sentinel events can be linked to communication errors that were made during a patient handoff.
The purpose for this evidence based practice project was to decrease the number of communication errors and reduce patient risks during handoff communication between operating room (OR) and PACU nurses by standardizing communication with the tested mnemonic phrase SBAR.
A unique setting subject to particular barriers to communication:
Noise
Interruptions
High rate of patient arrival & discharge
A lack of structure during handoff between OR and PACU nurses places surgical patients’ safety at risk as miscommunication is more common when handoff protocol is not standardized
(Abraham, Kannampallil & Patel, 2014; Kalkman, 2010; Petrovic, Aboumatar & Scholl et al., 2014; Petrovic, Martinez & Aboumatar, 2012; Riesenberg, Leitzsch & Cunningham, 2010; Riesenberg, Leitzsch & Little, 2009; The Joint Commission, 2015)

5. Review of Literature
The review of the literature began with searching several databases including CINAHL, ProQuest, Medline (PubMed), Medline (EbscoHOST), Cochrane Library, and the Joanna Briggs Institute. Keywords used to locate articles relevant to the PICOT question were: periop*, intraop*, handoff*, and handover*. Inclusion criteria consisted of being peer reviewed, from scholarly journals, must be an article, and be published in the English language after 2005.
After the initial searches were finished, 148 articles were eligible for inclusion based on titles and abstract content. Once these articles were selected, each was reviewed individually and chosen for inclusion in the literature review only if the source of evidence: (a) observed OR to PACU or ICU post procedure handoff; (b) used an intervention aimed at standardizing handoff protocol; (c) or used a checklist intervention. Sources of evidence were excluded if they did not include nurses or did not standardize handoff.
Initially only articles that sampled nurse handoff of surgical patients were included, but a lack of literature on this specific topic necessitated a broader inclusion of handoff literature.
Databases: CINAHL, ProQuest, Medline (PubMed), Medline (EbscoHOST), Cochrane Library, & Joanna Briggs Institute
Keywords: periop*, intraop*, handoff*, handover*
Inclusion Criteria:
Peer reviewed
Scholarly journals
Articles
English language
Published after 2005

6. Review of Literature
The abstract review revealed only 34 of the sources were relevant to the topic, several of which were doubles from different databases. A total of 11 sources of evidence were selected to be included in the review of literature and consisted of four systematic reviews, four qualitative studies, and three expert opinions or guidelines. As seen in the table, these were ranked by Melnyk & Fineout-Overholt’s levels of evidence and appraised using either the Critical Appraisal Skills Programme or Melnyk & Fineout-Overholt’s checklist for evidence-based clinical practice guidelines to ensure that the best evidence was utilized in the literature review.
As much of the literature reported qualitative findings, lower levels of ranking were assigned to many of the sources of evidence and these are the sources leveled at 5, 6, and 7. One systematic review included quantitative findings and this piece of literature was highly ranked as a level 1.
Much of the evidence was considered of good quality based on the Critical Appraisal Skills Programme; however, the table shows that the three expert opinions pieces of literature were considered fair based on Melnyk & Fineout-Overholt’s checklist for evidence-based clinical practice guidelines criteria.
Appraisal: Critical Appraisal Skills Programme (CASP) & Checklist for Evidence-Based Clinical Practice Guidelines
Source
Type
Level
Appraisal Score
Qualitative
Quantitative
Good
Fair
Systematic Reviews X I V
Single
Studies VI
Expert
Opinions
VII
(CASP, 2013; Melnyk & Fineout-Overholt, 2011)

7. Decision to Change Practice
The decision to change practice was made after completing the literature review and discovering a successful intervention supported by the literature. The evidence supported making use of a mnemonic phrase, as this aided in nurse memory by associating handoff items with a checklist and increased the inclusion of important patient information items. The literature also supported the use of a standardized protocol as this served to decrease handoff variability and reduce communication errors, both of which ultimately effect patient safety.
1. Mnemonic Phrase
Aids nurse memory
Associated with a handoff checklist
2. Standardized Protocol
Decreases handoff variability
Reduces communication errors risking patient safety
(Abraham, Kannampallil, & Patel, 2012; Greenberg et al., 2007; Holly & Poletick, 2013; Kalkman, 2010; Ong & Coiera, 2014; Riesenberg, Leitzsch, & Cunningham, 2010; Riesenberg, Leitzsch & Little, 2009; Petrovic, Aboumatar, & Scholl, 2015)

8. Implementation
Implementation of the Project took place in three phases, with each lasting two weeks, and resulted in a total duration of six weeks for the EBP project.
During the project, perioperative nurses were conveniently sampled based on the department work schedules.
During phase one, PACU and OR nurses each used the Handoff Evaluation form, a 24 item self-report form, to indicate which items were included in patient handoff from the OR to the PACU. These forms were paired using patient information, which was later removed, in order to keep nurses anonymous and compare the handoff items reported by both PACU & OR nurses during the same handoff. During this phase the project leader was present to ensure proper use of the Handoff Evaluation form.
Phase two began with an education session during each of the departments’ monthly meetings and relayed information via PowerPoint® about the importance of handoff standardization and the risks to patient safety. At this time demographic information was collected, with 10 OR nurses and 7 PACU nurses completing the demographic form. The PACU nurses reported an average of 20.2 years of experience with a range of 3–45 years. In comparison, the OR nurses reported an average of years of nursing experience with a range of 2.5–32 years. On average, the PACU nurses were 45.8 years old with ages ranging from years old, and the average age of the OR nurses was 42.9, with a range from age There were no significant differences in race or level of education between the two departments. The perioperative nurses present at the unit meetings also filled out the Safety Attitudes Questionnaire (SAQ), a 36 item Likert questionnaire that measured nurse perceptions of teamwork, patient safety, job satisfaction, stress recognition, perception of management, and working conditions.
PACU nurses continued to use the Handoff Evaluation forms, and implementation of the intervention began with OR nurses using the SBAR Handoff form. This form also consisted of 24 items and was a self-report form for OR nurses to report items they included during handoff to PACU nurses. In this phase the project leader was intermittently available to answer questions and monitor use of both forms.
In phase three, PACU nurses continued to use the Handoff Evaluation form and OR nurses continued to use the SBAR Handoff form. The project leader was not available for questions in this final phase in an attempt to monitor the success of the practice change.
Upon completion of the implementation, the SAQ was taken by perioperative nurses as a posttest to observe any changes nurse perceptions of teamwork or patient safety. An audit was also performed on the risk reports filed by nurses, called MIDAS reports. Four weeks prior to the intervention were audited and compared to the four weeks after the educational session, when the SBAR Handoff form was in use.
All forms used in this EBP project were collected in a locked box located in the PACU, with only the project leader having access to the forms.
Project Design: Three, two week phases for a project duration of six weeks
Phase One:
Handoff Evaluation Form:1-page form, measuring 24 items, PACU & OR
Phase Two:
Education Session: Handoff PowerPoint ® during staff meeting
Safety Attitudes Questionnaire (SAQ) Pretest: 36 safety items
Demographic Data
Handoff Evaluation Form:1-page form, measuring 24 items, PACU
SBAR Handoff form: 1-page form, measuring 24 items, OR
Phase Three:
Safety Attitudes Questionnaire (SAQ) Posttest
MIDAS Report Audit: risk report audit to measure change to patient safety

9. Perioperative Nurse Forms Handoff Evaluation Form
This EBP project was guided by the Iowa Model of Evidence-Based Practice and Lewin’s Model for Change. The six steps of the Iowa Model of Evidence-Based Practice influenced the foundational steps of the project, such as identifying the clinical problem, forming a PICOT question, performing the literature search, and analyzing and synthesizing the evidence.
The three phase implementation was chosen based on Lewin’s model of change which utilized 3 steps: unfreezing, moving, and refreezing. In phase one nurses began using the Handoff Evaluation form and unfreezing old practice habits. Phase two, moving, implemented a change by introducing the SBAR Handoff form. Phase three served to refreeze the nurses’ new behavior by removing the project leader.
Implementation
Perioperative Nurse Forms
Phase One
Phase Two
Phase Three
PACU OR
Handoff Evaluation Form X
SBAR Handoff Form
SAQ Pretest
SAQ Posttest

10. Data Analysis SBAR Handoff Form
The items included on the SBAR Handoff form were based on recommendations from The Joint Commission, the World Health Organization, and the Association of perioperative nurses.
Outcomes measured with this form were the 24 handoff items, which included things like Name, Allergies, Physician, Procedure, Dressings, etc.
These items were measured by a point system, with items indicated on the form as Yes or No scoring 1 point and items not indicated on the form scoring 0 points. Each form also received a total score out of a possible 24 points.
All statistical testing in this project was done through the computer program SPSS 22, and
Statistical Tests performed on the SBAR Handoff form included: Frequencies, Mean Scores, & Independent-Samples t Test.
SBAR Handoff Form
Outcomes: Inclusion of 24 handoff items
Measure: Individual items & total score
Statistical Tests: Frequencies, Mean Scores, & Independent-Samples t Test
Significance:
Frequencies: no significant changes in the reporting of individual items
Mean Scores: decreased from phase two to phase three
Independent-Samples t Test: 1 statistically significant item (Implants)

11. Data Evaluation SBAR Handoff Form
On this slide we see a table summarizing the test results from the SBAR Handoff form:
Frequencies completed on each individual item revealed that there were no significant differences in the frequency of any item reported when comparing phases two & three.
Mean total Scores showed there was no significant difference between the mean total scores from the OR in phases two & three, with the mean total score from decreasing from phase two (M = 12.38) to phase three at (M = 11.5).
Lastly, the Independent-Samples t Test: revealed only one item (Implants) was statistically significant, indicating that OR nurses reported their use of implants during a procedure less often, for example the use of hardware during a total knee or stent during a cystoscopy. It should be considered that this item may not have been applicable for some patients’ procedures, but the OR nurse failed to indicate the item was not applicable to the patient on the SBAR Handoff form.
Phase Two
Phase Three
Statistical Significance
Frequencies
No Significant items across Phases Two-Three
Mean Scores
(M = 12.38, SD = 3.69)
(M = 11.5, SD = 3.48)
(t(82) = 1.81, p = 0.241)
Independent-Samples t Test
Items
Result
Implants
(M = 0.92, SD = 0.28)
(M = 0.57, SD = 0.51)
(t(25) = 2.19, p < 0.038)

12. Handoff Evaluation Form
Data Analysis
The Outcomes on the Handoff Evaluation form: were the same as the SBAR Handoff form and consisted of 24 handoff items, which included things like: Name, Allergies, Physician, Procedure, Dressings, etc.
These outcomes were measured using a point system based on items indicated on the form, with Yes and No answers scoring 1 point and items not indicated on the form scoring 0 points. Each form also received a total score out of a possible 24 points.
Statistical Tests: included Frequencies, Mean Total Scores, an Independent-Samples t Test, a Paired-Samples t Test, & Analysis of Variance or ANOVA.
Handoff Evaluation Form
Outcomes: Inclusion of 24 handoff items
Measure: Individual items & total score
Statistical Tests: Frequencies, Mean Scores, Independent-Samples t Test, Paired-Samples t Test & ANOVA
Significance:
Frequencies: no significant changes in the reporting of individual items
Mean Scores: PACU > OR (phase one), PACU scores decreased from phase two-three
Independent-Samples t Test: 3 statistically significant items (NPO, Skin, Shift)
Paired-Samples t Test: 3 statistically significant items (NPO, Skin, Shift)
ANOVA: not significant for PACU mean scores or for PACU Handoff Evaluation forms from all three phases

13. Data Evaluation Handoff Evaluation Form
On this slide we see the results of the testing completed on the Handoff Evaluation form.
The frequencies run on the 24 items showed no significant difference in the frequency of any individual item reported when comparing the PACU forms from phases 1, 2, & 3.
Mean total Scores revealed: that there was no significant difference between the total number of received handoff items reported by the PACU nurses in any of the phases, with the mean total score from phase 1 as (M = 8.14), and increasing in phase two to (M = 8.31), and decreasing in phase three to (M = 7.57). While there was a promising trend between phases 1 & 2, when the project leader left the unit in phase 3 mean total scores dropped.
The Analysis of Variance, or ANOVA, completed on the PACU mean total scores showed no significant differences between scores in all three phases. In comparison, the mean total score on the Handoff Evaluation form in the OR from phase one was (M = 8.87) and this was slightly higher than the mean reported in the PACU, although not significantly. This meant that OR nurses reported giving more items in handoff than PACU nurses reported receiving.
The Independent-Samples t Test: revealed three items (NPO, Skin, & Shift) were statistically significant. The NPO item indicated the time of the patient’s last oral consumption of food or drink; the Skin item referred to the patient’s skin integrity; and the shift item referred to the nurses’ communication we each other about their availability in the department. For each of these three items the PACU nurses reported receiving the item during handoff more often than the OR nurses reported giving them.
The Paired-Samples t Test was compared the Handoff Evaluation forms from both the OR & PACU from phase one. This test revealed the same three items (NPO, Skin, & Shift) were statistically significant. Again, the PACU nurses reported receiving each item during handoff more often than the OR nurses reported giving them.
The ANOVA performed on the three phases of PACU Handoff Evaluation forms revealed no significant changes between the three phases and eliminated the need for Post Hoc Testing.
Phase One
Phase Two
Phase Three
Frequencies
No Significant items across Phases One-Three
Mean Scores
PACU (M = 8.14, SD = 3.2)
PACU (M = 8.31, SD = 3.4)
PACU (M = 7.57, SD = 3.25)
OR (M = 8.87, SD = 4.15)
Paired-Samples t Test
OR SBAR Handoff & PACU Handoff Evaluation
Independent-Samples t Test
Item
Result
NPO
PACU (M = 2.71, SD = 0.46)
PACU (M = 2.71, SD = .46)
OR (M = 1.5, SD = 0.86)
OR (M = 1.50, SD = 0.86)
(t(41) =7.51, p < 0.00)
(t(82) = 8.061, p = 0.00)
Skin
PACU (M = 2.98, SD = 0.15)
PACU (M = 2.98, SD = .15)
OR (M = 2.62, SD = 0.77)
OR (M = 2.62, SD = 0.76)
(t(41) = 2.93, p < 0.006)
(t(82) = -2.97, p = 0.004)
Shift
PACU (M = 1.24, SD = 0.62)
PACU (M = 1.24, SD = .62)
OR (M =1.02, SD = 0.15)
OR (M = 1.02, SD = 0.15)
(t(41) = 0.04, p < 0.037)
(t(82) = 2.18, p = 0.032)
ANOVA
PACU Handoff Evaluation Form
No Significant Results (No Post Hoc Testing)
PACU Mean Scores
No Significant Results (F(66,68) = .21, p = .81)

14. Safety Assessment Questionnaire (SAQ)
Data Analysis
The Outcomes: from the SAQ included the perioperative nurses’ answers to the 36 Likert scale scored items, with 3 of the items having reverse scores and 5 of the items specifically scoring management. These items made up six subsections including: teamwork, patient safety, job satisfaction, stress recognition, perception of management, and working conditions; with each subsection receiving an individual total score.
Measure: The measure of each individual item was based on a Likert scale, with each item scoring anywhere from 1-5 points. A strongly disagree answer received 1 point and a strongly agree answer received 5 points. These points were added up according to subsection and assigned a percent (%) as a total score for each of the subsections.
Statistical Testing: for the SAQ included Independent-Samples t Tests for the Pretests and Posttests individually; & also a Paired-Samples t Test was completed to compare the pretests to the posttests.
Safety Assessment Questionnaire (SAQ)
Outcomes: 36 items scoring perioperative nurse perceptions of teamwork, safety, job satisfaction, stress recognition, perception of management, and working conditions
Measure: Likert Scale & 6 Subsections Total Score (%)
Statistical Testing: Independent & Paired-Samples t Tests
Significance: Independent-Samples t Test showed 4 significant items (Ask Questions, Good Job B, Problem Personnel B, & Timely Info B) & Paired-Samples t Test showed eight significant items (Family, Daily Efforts B, Compromise Patient Safety B, Good Job B, Problem Personnel B, Timely Info B, Level of Staffing, and Communication Breakdowns)
Teamwork & Patient Safety Scores: not significantly different

15. Data Evaluation SAQ Pretest Posttest Pretest & Posttest
This table shows results from the SAQ testing, with the first column showing the 4 significant items between the OR & PACU pretests, the second column showing 8 significant items between the OR & PACU posttests, and the last column showing the one significant item between both departments. Each column includes the mean score for the OR and PACU as well as the significance for each individual item.
The Independent-Samples t Test: individually evaluated both the Pretests and Posttests. The pretest results revealed four significant items (Ask Questions, Good Job B, Problem Personnel B, & Timely Info B), with all these items being scored lower, or more negatively, in the OR. The Ask Questions item indicated the nurses’ comfort level asking questions, the Good Job B item referred to perioperative nurses’ perceptions of management’s ability perform in a leadership role, the Problem Personnel B item evaluated nurse perceptions that management could identify problematic staff, and the Timely Info B item related to the nurses’ perceptions that management released information to the staff in a timely manner.
The posttests revealed eight significant items including: (Family, Daily Efforts B, Compromise Patient Safety B, Good Job B, Problem Personnel B, Timely Info B, Level of Staffing, and Communication Breakdowns), with each of these items reporting higher scores, or being more positively perceived, in the OR. This was an interesting shift in OR nurse perceptions, as four of these items were also significant on the pretest and essentially reversed scores on the posttest.
The Family item referred to perioperative nurse perceptions that when personal family issues arose they would be respected; Daily Efforts B addressed nurse perceptions of management correctly evaluating daily work; Compromise Patient Safety B directly related to management’s ability to assess problems with patient safety; level of staffing is fairly self-explanatory; and lastly communication breakdowns referred to the nurses perceptions of communication barriers.
The Paired-Samples t Test compared the pretests to the posttests and supported only one significant item (Support) between the OR and PACU, which was scored significantly higher on the pretest than the posttest. This item refereed to perioperative nurses’ perceptions that they had support in their workplace.
Ultimately, the scores on the subsections of Teamwork & Patient Safety from the PICOT question were not significantly different between departments or from pretest to posttest.
Pretest
Posttest
Pretest & Posttest
Independent-Samples t Test
Paired-Samples t Test
Item
Results
Ask Questions
OR (M = 2.70, SD = 1.16)
Family
OR (M = 4.43, SD = 0.79)
Support
pretest (M = 4.58, SD = 0.67)
PACU (M = 3.86, SD = 1.07)
PACU (M = 3.00, SD = .71)
posttest (M = 3.92, SD = 0.90)
(t(15) = -2.14, p = 0.050)
(t(10) = 3.227, p = 0.009)
(t(11) = 2.60, p = 0.025)
Good Job B
OR (M = 2.20, SD = 1.87)
Daily Efforts B
OR (M = 2.86, SD = 1.46)
PACU (M = 4.29, SD = 0.95)
PACU (M = .00, SD = .00)
(t(15) = -2.69, p = 0.017)
(t(10) = 4.03, p = 0.002)
Problem Personnel B 
OR (M = 1.20, SD = 1.03)
Compromise Patient Safety B
OR (M = 3.57, SD = 1.81)
PACU (M = 3.57, SD = 0.79)
(t(10) = 4.34, p = 0.001)
(t(15) = -5.11, p = 0.000)
Timely Info B
OR (M = 2.0, SD = 1.69)
OR (M = 3.29, SD = 1.70)
PACU (M = 4.0, SD = 0.82)
(t(10) = 4.25, p = 0.002)
(t(15) = -2.87, p = 0.012)
Problem
Personnel B
OR (M = 2.00, SD = 1.63)
(t(10) = 2.70, p = 0.022)
OR (M = 3.00, SD = 1.53)
(t(10) = 4.33, p = 0.001)
Level of Staffing
OR (M = 3.14, SD = 1.07)
PACU (M = 1.60, SD = .89)
(t(10) = 2.63, p = 0.025)
Communication Breakdowns
OR (M = 2.71, SD = 0.76)
PACU (M = 1.40, SD = 1.14)
(t(10) = 2.42, p = 0.036)

16. Data Analysis & Evaluation
The Outcome: for the MIDAS reports were the numbers of reports filed by perioperative nurses following a communication error from OR nurse to PACU nurse in the PACU.
The Measure: was based on the number of reports filed 4 weeks prior to beginning use of the SBAR Handoff form and this number was compared to the number of reports filed 4 weeks after the implementation of the SBAR Handoff form.
Statistical Tests & Significance: In this case no testing was required, as there were no risk reports filed during this time frame and no change in reported events related to perioperative patient safety occurred.
MIDAS Risk Report Audit
Outcomes: process used by perioperative nurses to file risk reports
Measure: the number of reports filed 4 weeks prior to intervention were compared to the number of reports filed 4 weeks after the education session
Statistical Tests: No testing required
Significance: No change in reported events pertaining to perioperative patient safety
Before Education Session
After Education Session
 MIDAS Report Audit

17. Recommendations
Literature support the use of a mnemonic phrase and standardized handoff protocol during nurse handoff to reduce risks to patient safety. Additional recommendations are that future repeating of the EBP project should take place during a time when fewer changes are happening simultaneously and that it should be implemented over a longer period of time in order to better evaluate the practice change.
Literature supports the use of a mnemonic phrase and standardized handoff protocol during nurse handoff to reduce risks to patient safety
Repeat the project during a time when fewer changes are happening simultaneously
Repeat project over a longer period of time

18. Conclusions
In conclusion, the implementation of a written SBAR Handoff form was not successful in standardizing perioperative nurse Handoff from the OR to the PACU. Ultimately, the mean scores of reported items from the SBAR Handoff and Handoff Evaluation forms decreased; however, there was a promising trend from phase one to phase two. Relatively few items showed significance with statistical testing, indicating that perioperative nurse handoff practices did not change enough to consider handoff standardized. In addition the SAQ revealed that perioperative nurse perceptions of Teamwork and Patient Safety did not significantly change from the pretest to the posttest. Lastly, the MIDAS risk report audit supported these conclusions by showing no change in nurse reported patient safety events in the PACU.
Thank you for your attention. I believe I have a few minutes for a few questions.
Implementation of a written SBAR Handoff form was not successful in standardizing perioperative nurse Handoff from the OR to the PACU
SBAR Handoff Forms: Mean scores decreased from Phase Two- Three and the Implants item decreased in handoff inclusion
Handoff Evaluation Forms: Phases One-Two revealed promising trends in mean scores, but overall project statistical testing showed only 3/24 items improved with the intervention
SAQ: Perioperative nurse perceptions of Teamwork and Patient Safety showed variations in individual items
MIDAS Audit: No change in nurse reported patient safety events

19. References
Abraham, J., Kannampallil, T., & Patel, V. (2014). A systematic review of the literature on the evaluation of handoff tools: Implications for research and practice. Journal of the American Medical Informatics Association, 21, doi: /amiajnl
Critical Appraisal Skills Programme (CASP). (2013). Making Sense of the Evidence. Retrieved from uk.net/
Holly, C., & Poletick, E. (2013). A systematic review on the transfer of information during nurse transitions in care. Journal of Clinical Nursing, 23, doi: /jocn.12365
Greenberg, C., Regenbogen, S., Studdert, D., Lipsitz, S., Rogers, S., Zinner, M., & Gawande, A. (2007). Patterns of communication breakdowns resulting in injury to surgical patients. The American College of Surgeons, 204(4), doi /j.jamcollsurg
Kalkman, C. (2010). Handover in the perioperative care process. Current Opinion in Anesthesiology, 23, doi: /ACO.0b013e32834acB
Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare. Philadelphia, PA: LWW.
Ong, M. & Coiera, E. (2011). A systematic review of failures in handoff communication during intrahospital transfers. The Joint Commission Journal of Quality and Patient Safety, 37(6)
Petrovic, M., Aboumatar, H., Scholl, A., Krenzischek, D., Camp, M., Senger, C., Chang, T., Jurdi A., & Martinez, E. (2014). The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units. Journal of Clinical Anesthesia, 27,
Petrovic, M., Martinez E., & Aboumatar, H. (2012). Implementing a perioperative handoff tool to improve postprocedural patient transfers. The Joint Commission Journal on Quality and Patient Safety, 38(3)
Riesenberg, L., Leitzsch, J., & Cunningham, J. (2010). Nursing handoffs: A systematic review of the literature. American Journal of Nursing, 110(4),
Riesenberg, L., Leitzsch, J., & Little, B. (2009). Systematic review of handoff mnemonics literature. American Journal of Medical Quality, 24(3), doi: /
The Joint Commission. (2015). National Patient Safety Goal Retrieved from