Validation of a handoff assessment tool: the Handoff CEX

Authors

  • Leora I Horwitz,

    1. Authors:Leora I Horwitz, MD, MHS, Assistant Professor, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT; Janet Dombroski, PhD, RN, Clinical Nurse Educator, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, CT; Terrence E Murphy, PhD, Research Scientist, Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT; Jeanne M Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA; Julie K Johnson, PhD, Associate Professor, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia; Vineet M Arora, MD, MAPP, Associate Professor, Section of Hospital Medicine, Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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  • Janet Dombroski,

    1. Authors:Leora I Horwitz, MD, MHS, Assistant Professor, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT; Janet Dombroski, PhD, RN, Clinical Nurse Educator, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, CT; Terrence E Murphy, PhD, Research Scientist, Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT; Jeanne M Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA; Julie K Johnson, PhD, Associate Professor, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia; Vineet M Arora, MD, MAPP, Associate Professor, Section of Hospital Medicine, Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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  • Terrence E Murphy,

    1. Authors:Leora I Horwitz, MD, MHS, Assistant Professor, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT; Janet Dombroski, PhD, RN, Clinical Nurse Educator, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, CT; Terrence E Murphy, PhD, Research Scientist, Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT; Jeanne M Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA; Julie K Johnson, PhD, Associate Professor, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia; Vineet M Arora, MD, MAPP, Associate Professor, Section of Hospital Medicine, Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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  • Jeanne M Farnan,

    1. Authors:Leora I Horwitz, MD, MHS, Assistant Professor, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT; Janet Dombroski, PhD, RN, Clinical Nurse Educator, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, CT; Terrence E Murphy, PhD, Research Scientist, Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT; Jeanne M Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA; Julie K Johnson, PhD, Associate Professor, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia; Vineet M Arora, MD, MAPP, Associate Professor, Section of Hospital Medicine, Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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  • Julie K Johnson,

    1. Authors:Leora I Horwitz, MD, MHS, Assistant Professor, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT; Janet Dombroski, PhD, RN, Clinical Nurse Educator, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, CT; Terrence E Murphy, PhD, Research Scientist, Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT; Jeanne M Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA; Julie K Johnson, PhD, Associate Professor, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia; Vineet M Arora, MD, MAPP, Associate Professor, Section of Hospital Medicine, Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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  • Vineet M Arora

    1. Authors:Leora I Horwitz, MD, MHS, Assistant Professor, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT; Janet Dombroski, PhD, RN, Clinical Nurse Educator, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, CT; Terrence E Murphy, PhD, Research Scientist, Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT; Jeanne M Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA; Julie K Johnson, PhD, Associate Professor, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, Australia; Vineet M Arora, MD, MAPP, Associate Professor, Section of Hospital Medicine, Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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Leora Horwitz, Assistant Professor, Section of General Internal Medicine, PO Box 208093, New Haven, CT 06520-8093, USA. Telephone: +1 (203) 688 5678.
E-mail: leora.horwitz@yale.edu

Abstract

Aims and objectives.  Test the feasibility and validity of a handoff evaluation tool for nurses.

Background.  No validated tools exist to assess the quality of handoff communication during change of shift.

Design.  Prospective cohort study.

Methods.  A standardised tool, the Handoff CEX, was developed based on the mini-CEX. The tool consisted of seven domains scored on a 1–9 scale. Nurse educators observed shift-to-shift handoff reports among nurses and evaluated both the provider and recipient of the report. Nurses participating in the report simultaneously evaluated each other as part of their handoff.

Results.  Ninety-eight evaluations were obtained from 25 reports. Scores ranged from 3–9 in all domains except communication and setting (4–9). Experienced (>five years) nurses received significantly higher mean scores than inexperienced (≤five years) nurses in all domains except setting and professionalism. Mean overall score for experienced nurses was 7·9 vs 6·9 for inexperienced nurses. External observers gave significantly lower scores than peer evaluators in all domains except setting. Mean overall score by external observers was 7·1 vs. 8·1 by peer evaluators. Participants were very satisfied with the evaluation (mean score 8·1).

Conclusions.  A brief, structured handoff evaluation tool was designed that was well-received by participants, was felt to be easy to use without training, provided data about a wide range of communication competencies and discriminated well between experienced and inexperienced clinicians.

Relevance to clinical practice.  This tool may be useful for educators, supervisors and practicing nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.

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