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Prepare a minimum 10-minute narrated PowerPoint presentation. The presentation should be 15–20 slides in length, not including your cover slide or reference slide. Your reference slide should cite at least 10 references.
Your presentation should, at the minimum, include discussion of the following topics regarding your change project:
Change Project: Improving Patient Handoff Communication
Rough Draft
Problem Identification and Description Using PICOT Format
Problem Identification and Clinical Setting Description
Safe and effective healthcare needs proper patient handoff communication. Although crucial in clinical settings, handoff communication between nursing shifts is often unstandardized, inconsistent, and incomplete, increasing the risk of errors and poor patient outcomes. Handoff strategies vary across nursing staff in hospitals and outpatient settings, including my high-volume urban medical-surgical unit at a regional public hospital. others use memory or handwritten notes, others use minimal documentation from the electronic health record (EHR), and some make rushed or unstructured verbal reports due to shift change time needs.
The clinical environment consists of a 36-bed adult medical-surgical and patient care unit located in a large metropolitan tertiary care hospital. The hospital serves a diverse population of aged, chronically sick, and impoverished patients. The microsystem is made up of the nursing staff and their patient transfer protocols at shift start and end. Depending on shift and patient acuity, nurses transfer 4–6 patients to the next nurse three times a day. This hospital handles low-income urban patients with poor health literacy and complex care needs, making clear and precise handoffs essential for safe, high-quality care.
Clinical observations revealed many issues during patient handoffs. Incomplete information transfer misplaced or incorrect medicine or care documentation, and lack of patient participation in the handoff process are examples. Weekends and nights have higher communication difficulties owing to fewer staffing and weariness. Redundant tasks, care delays, prescription errors, and patient discontent result from poor communication. Failure to implement a structured handoff strategy in nursing practice causes many preventable errors.
Explicit Statement of the Problem and Background to substantiate the change project
The specific problem this project seeks to address is: Inconsistent and ineffective handoff communication between nursing shifts leads to information gaps, patient safety risks, and decreased care quality in adult medical-surgical units. The target population includes adult patients admitted to the inpatient medical-surgical unit and the nursing staff responsible for their care. The PICOT-formatted question guiding this project is: In adult medical-surgical units (P), how does implementing a standardized, evidence-based handoff protocol (I), compared to current unstructured handoff practices (C), affect the completeness of patient information transfer and reduction in adverse events (O) during 12 weeks (T)?
The issue is sufficiently broad to allow for several theoretical and conceptual analysis lenses. Lean and Six Sigma are systems, communication, and quality improvement frameworks. Microsystemically, Handoff reflects team culture, workflow design, individual competence, and organizational support systems. The Iowa Model and Johns Hopkins Nursing EBP Model are two examples of evidence-based practice (EBP) approaches that may guide clinical research and the use of EBP interventions. It has personal and professional significance. As a nurse, I’ve witnessed poor handoffs cost vulnerable patients care. Stressing novice nurses may cause burnout, poor morale, and high turnover, harming patient care. I want to learn more about this topic because I want to improve patient care, communication, and nursing workflow. I am willing to invest time this semester examining the handoff problem, designing successful interventions, and building a clinically applicable evaluation system.
Significance of the Evidence-Based Project to the Nursing Profession
(let out in this part of the change project)
Summary of the change project
Clinical practice is plagued by inconsistent and ineffective communication during nursing handoffs between shifts. It reduces patient safety, increases adverse events, and makes medical-surgical personnel unhappy and exhausted at a major urban hospital. National recommendations like SBAR and I-PASS cannot eliminate variability and error without a unit-specific handoff technique. Employing a microsystem approach allows us to develop a realistic, scalable, and successful unit-level evidence-based intervention. The suggested program addresses a practice gap, promotes patient safety, and may improve patient and staff outcomes. It relates to nursing and my clinical interests and professional development goals. The topic’s breadth and complexity enable semester-long theoretical analysis, rigorous assessment, and practical intervention planning.
change Project Benefits in Terms of Cost, Time, and Quality
Healthcare sentinel events, pharmaceutical errors, patient dissatisfaction, and extended hospital stays are often caused by poor handoff communication. The handoff communication project addresses these systemic inefficiencies by improving patient information transfer between healthcare providers. Standardised handoffs improve clinical accuracy, eliminate miscommunication, and improve patient outcomes. Jorro-Barón et al. (2021) found that standardised handoff programs reduced medical errors by 23% and avoidable adverse events by 30%. These enhancements boost patient safety and care quality.
Improved communication at transitions of care reduces duplicative testing, liability, and readmissions, lowering institutional costs. Poor handoffs lead to preventable adverse events and hospital expenses, according to Desmedt et al. (2021). Simplified workflows save clinicians time explaining or correcting handoff information, improving resource allocation. Standardising handoff processes improves clinical and operational workflows by improving continuity of care, eliminating redundancy, and speeding decision-making.
Change project Goals and Objectives Linked to Project Success
The overarching goal of the project is to improve the quality and consistency of patient handoff communication within the healthcare institution through the adoption of a standardized protocol such as SBAR (Situation, Background, Assessment, Recommendation) or I-PASS (Illness severity, Patient summary, Action list, Situation awareness, and Synthesis). The measurable objectives aligned with this goal include: (1) reducing the rate of handoff-related errors by at least 25% within six months of implementation, (2) improving staff compliance with handoff procedures to 90% adherence within three months, and (3) enhancing staff satisfaction with the handoff process, as measured by post-implementation surveys.
These goals and objectives reflect stakeholder consensus, including nurse managers, physicians, patient safety officers, and administrators. Success is dependent on shared ownership of outcomes, where all participants recognize the importance of communication during patient transitions. Establishing clear, measurable targets allows stakeholders to monitor progress and adjust strategies as needed. As Brown et al., (2023) emphasize, successful communication improvement projects are those that define achievable goals, receive leadership support, and promote interdisciplinary collaboration. In this project, aligning institutional priorities with frontline staff needs promotes sustainable change, contributing to the project’s success.
The timeline for the project is as follows:
· Month 1: Conduct baseline assessments, including error rates and staff satisfaction surveys. Form a multidisciplinary implementation team.
· Month 2–3: Develop training materials and conduct educational sessions on the selected handoff protocol.
· Month 4–5: Pilot the protocol in one unit (e.g., the medical-surgical floor), collect real-time data, and refine the implementation strategy based on feedback.
· Month 6–7: Expand the intervention hospital-wide, including integration with EHR systems and regular compliance audits.
· Month 8–9: Conduct post-implementation surveys, compare data to baseline, and report outcomes to stakeholders.
· Month 10: Publish findings, host staff debrief sessions and develop long-term maintenance strategies such as annual refresher training and policy updates.
While actual implementation is beyond the scope of this academic exercise, the projected timeline ensures accountability and provides a structured framework for translation into real-world practice.
Summary of the Change Project
Improving Patient Handoff Communication
Literature Review
Patient safety, quality of treatment, and clinical results depend on effective patient handoff communication. Patient handoff, also known as clinical handover or transition of care, includes transferring vital patient data and responsibilities between healthcare providers or teams. Shift changes, interdepartmental transfers, and discharge processes are subject to communication breakdowns that can cause medical errors, adverse events, and care continuity issues. Recent studies show that healthcare accrediting authorities like The Joint Commission describe handoff communication difficulties as a primary cause of sentinel events. Many healthcare systems lack evidence-based handoff communication guidelines despite their focus on patient-centered care and teamwork. Handoff methods across specialties, time restrictions, cognitive overload, and inadequate technology use contribute to care transition discrepancies. This integrative literature review critically evaluates and synthesizes peer-reviewed research and professional guidelines on patient handoff communication tactics. The review examines standardized communication tools, technology-assisted handoffs, interdisciplinary collaboration, training methods, and organizational impacts from medical, nursing, and public health. Assessing what is known, what is unknown, and how these insights might enhance advanced nursing practice and policy is the goal. This review also highlights knowledge gaps that must be addressed to improve safe, consistent, and patient-centered handoffs across varied care settings.
Theoretical and Conceptual Frameworks ( change project)
Understanding and improving patient handoff communication involves theoretical and conceptual foundations for practice and research. SBAR (Situation, Background, Assessment, Recommendation) and Transitions Theory are essential methods for designing and analyzing patient transition communication. SBAR, established by the U.S. Navy and modified for healthcare, encourages brief, focused, and relevant information exchange among healthcare practitioners. It divides handoff exchanges into the current circumstance, relevant background, clinical assessment, and clear recommendation. Numerous studies have shown that the SBAR framework improves communication, teamwork, and patient safety. It is useful in emergency departments, intensive care units, and shift changeover.
Afaf Meleis’ Transitions Theory provides a broader framework for understanding human transformation, encompassing health status, care settings, and care providers. This theory emphasizes the vulnerability of patients and clinicians during handoffs and the necessity for planning, role clarity, and effective communication to guarantee continuity of care. The idea takes a holistic perspective to clinical processes and interpersonal dynamics that affect handoffs. These frameworks emphasize structured communication, relational skills, and systemic support for patient handoffs. They underpin advanced practice nursing and interdisciplinary care delivery intervention design, communication evaluation, and policy formulation.
Synthesis of the Literature
Effective patient handoff communication is critical to patient safety and quality care across healthcare specialties. Standardized tools, technological breakthroughs, interdisciplinary collaboration, education, and supportive corporate cultures make handoffs safer and more effective, according to nursing, medical, and public health literature. Thematically synthesizing the research, this section highlights important areas of attention and their significance to patient handoff communication.
Standardized Communication Tools and Protocols in the change project
Literature emphasizes standardized handoff methods to reduce communication unpredictability and increase patient safety. Situation, Background, Assessment, Recommendation is a popular model. Parker (2022) states that the SBAR framework improves clarity, critical thinking, and clinical information communication during care transitions. Beyrau et al. (2025) found that the mnemonic-based I-PASS procedure for physician handoffs dramatically reduced pediatric avoidable adverse events. Multiple clinical guidelines recommend SBAR and I-PASS as evidence-based procedures that prevent essential information omission. However, other research note universal applicability restrictions. Internal medicine and nursing professionals may find structured instruments excessively rigid, limiting narrative context or clinical judgment (Asadi et al., 2024). These tools provide a common language for communication, but contextual customization, continuing training, and interprofessional buy-in are often needed for success.
What We Know and How Well We Know It
Structured handoff solutions like SBAR and I-PASS are proven to reduce information omissions, improve clarity, and improve healthcare provider communication. These technologies reduce adverse outcomes, especially in high-risk situations like emergency departments and intensive care units, according to multiple RCTs and quasi-experimental studies (Cui & Wang, 2025). Simulation-based training improves provider confidence, communication, and situational awareness (Abildgren et al., 2022). Technology, especially EHR-integrated handoff systems, can ensure quick and accurate information transfer. Study shows these solutions improve documentation completeness and provider satisfaction (Albagmi, 2021). Organizational culture, leadership engagement, and interdisciplinary collaboration boost handoff improvement success and sustainability. National safety programs should include standardized handoff practices, according to safety organizations like The Joint Commission and AHRQ.
What We Do Not Know
Many knowledge gaps persist despite these gains. First, handoff strategies’ long-term sustainability and transferability across ambulatory, rural, and home health settings are unknown. Most research has been done in hospitals, limiting generalizability. Second, it is unclear how advanced practice nurses (APNs), physicians, and allied health professionals view and perform handoffs. The ability to build truly interprofessional care communication models is limited.
Few studies have thoroughly examined patient involvement in handoff processes, especially nurse bedside shift reports. Few data exist on culturally sensitive handoffs and communication techniques that address linguistic or health literacy problems. There are few indicators to assess handoff quality and outcomes across institutions. These deficiencies require more comprehensive, longitudinal, and context-sensitive research to understand and improve handoff communication across all care delivery domains.
Gaps in Knowledge and Implications for Advanced Practice Nursing
Several evidence-based handoff communication strategies exist, but major limitations prevent full implementation and generalizability. Advanced practice nursing combines clinical leadership, interdisciplinary coordination, and quality improvement, making these gaps particularly critical.
Identified Gaps in Knowledge
There is little study on handoff communication in non-hospital and community settings. Most studies focus on acute care, neglecting primary, long-term, home health, and telehealth. Lack of context-specific handoff studies may split treatment and overlook safety improvements as healthcare moves toward outpatient and decentralized models. Insufficient patient-centered and culturally sensitive handoffs are another issue. Nurse bedside shift reports involve patients in communication, but few research examine how they use the information. Language, cultural, and health literacy barriers that may hinder patient understanding or engagement are addressed even less. Without addressing these concerns, handoff improvements may not achieve care equity and inclusivity.
Handoff quality is also not measured rigorously. Many interventions are evaluated based on process adherence (e.g., SBAR use) rather than clinical outcomes like patient harm, readmissions, or satisfaction. Without established measures, benchmarking and institution-wide improvement are difficult. Few research have examined interprofessional handoff perception and practice. Handoffs vary by nurse, doctor, pharmacist, and advanced practice nurse expectations, communication styles, and training. Most research portrays healthcare workers as a homogenous group, ignoring interpersonal and disciplinary variables that affect handoff implementation.
change project Implications for Advanced Practice Nursing
Clinical leadership, education, and systems-level advocacy make advanced practice nurses (APNs) ideal for filling these gaps. APNs can establish various care environment-specific interdisciplinary handoff protocols as clinical experts and change agents. They can also promote inclusive communication by ensuring handoff tools and training accommodate linguistic variety, patient engagement, and cultural awareness. The formulation of quality measurements, outcomes-based evaluations, and practice improvements can be led by APNs. APNs can sustain handoff practices by incorporating communication training into staff development and mentorship initiatives.
Summary
Patient safety, continuity, and efficiency depend on better patient handoff communication. The research highly recommends SBAR, I-PASS, technological integration, interdisciplinary collaboration, and simulation-based instruction to improve handoff quality and consistency. However, outpatient and community research, culturally competent handoff, and outcome-based evaluations are lacking. These issues prevent handoff strategy improvement and adaption across care settings. Advanced practice nurses can lead change by applying evidence-based practices, promoting patient-centered communication, and creating measurable quality improvement programs. Structured, effective, and inclusive handoff communication will become more important as healthcare systems become more complicated. Research, policy, and practice must fill gaps to improve hospital and non-hospital safety and quality.
The Theoretical Framework of the change project
Improving Patient Handoff Communication: Conceptual Framework
Communication during patient handoff is a vital element of patient safety, care continuity, and minimizing the occurrence of adverse events (Webster et al., 2022). Ineffective handoff contributes to care quality concerns and medical errors in various healthcare facilities. This project undertakes the exploration and adoption of structured handoff communication systems among nurses. To support this effort, a conceptual framework guided by applicable theory will be used in the research. Using the chosen theories, the project will examine how effective communication mechanisms can be structured to provide better outcomes, facilitate teamwork, and establish a safer healthcare landscape between patients and medical professionals.
Selected Theories
Kurt Lewin Change Theory and the Theory of Human Caring by Jean Watson are the two theories that will inform this investigation.
Effective patient handoff communication is critical to ensuring patient safety, continuity of care, and reducing adverse events (Webster et al., 2022). It assists healthcare organizations in planning the change, such as strengthening communication (Stanz et al., 2021). Unfreezing takes place when stakeholders perceive change. The transformation phase generates the new habits and the refreezing phase institutionalizes them. This concept provides a systematic take on healthcare organization reformation.
The Theory of Human Caring by Jean Watson is about the importance of interpersonal relationships and holistic nursing in the nursing profession. Curcio et al. (2024) say that carative elements provide a caring environment that is nurturing and has trusting relationships. This hypothesis suggests that real, caring nurse-to-nurse handoff communication improves information transmission, collaboration, and patient safety. Watson’s paradigm encourages nurses to collaborate and stress human connection in every communication.
Process and Logic in Selecting Theories in the change project
The selection of Lewin’s Change Theory and Watson’s Theory of Human Caring stems from the study’s practical and philosophical demands. Lewin’s approach provides a tangible mechanism for systemic behavior change, which is ideal for procedural improvements like standardization of handoff communication. Its incremental method improves stakeholder participation, assessment, and change sustainability. However, Watson’s philosophy protects humanistic and relational communication. Nurses need empathy, trust, and teamwork to make good handoffs (Webster et al., 2022). A dual-theory approach facilitates mechanical (process improvement) and humanistic (interpersonal connection) handoff communication. Combining these ideas provides a comprehensive framework to examine what needs to change and how and why human-centered methods might improve patient care.
Application of Theories to the Project
Lewin’s Change Theory applies to implementing a standardized handoff protocol, such as SBAR (Situation-Background-Assessment-Recommendation). During the unfreezing stage, nurses and stakeholders will be educated on the risks of poor handoffs, including missed or incomplete information and patient harm. SBAR-based training and simulations will strengthen organized communication throughout transformation. Policy changes, constant monitoring, and feedback mechanisms will be used during refreezing to make the new handoff approach routine. This theory ensures that change is intentional, gradual, and rooted in awareness and participation.
Watson’s Theory of Human Caring provides the relational context in which these changes occur. Nurses should see each other as partners, not just job performers. Respected and supported nurses are more likely to speak freely and extensively during handoffs. Nurses should be present, listen attentively, and communicate empathetically because good handoffs are about shared responsibility and care, not simply clinical facts. A mutual respect and awareness culture makes the handoff procedure a meaningful act of professional solidarity and patient advocacy.
APRN Role and Clinical Practice Implications in the change project
Advanced practice registered nurses (APRNs) play a pivotal role in leading handoff improvement initiatives. APRNs serve as both clinical experts and change agents, bridging direct patient care with systems-level improvement. In this project, the APRN’s role will include:
Facilitator and Educator – Training staff standardized handoff protocols, conducting workshops, and developing simulation scenarios. APRNs bring advanced clinical expertise and credibility, enhancing staff buy-in.
Data Analyst and Evaluator – Collecting, analyzing, and interpreting data on handoff quality, error rates, and patient outcomes. APRNs apply evidence-based frameworks to measure effectiveness and guide iterative refinements.
Collaborator and Advocate – Partnering with administrators, IT specialists, and community agencies to secure resources, integrate tools into EHR systems, and align with organizational policies.
Policy Influencer – Advocating for institutional policies that protect handoff time, reduce interruptions, and sustain long-term adoption of best practices.
Clinical applications enhance patient safety, reduce sentinel events, and improve interprofessional practice. In addition, standardized handoffs can reinforce continuity of care between settings, especially in community-based transitions where APRNs often coordinate primary care and home health agencies. Finally, the project furthers the nursing profession’s pursuit of patient advocacy and quality improvement.
Addressing Knowledge GapsIN THE change project
This project closes several knowledge gaps. While various studies document the strength of structured tools, very few examine the collaborative effect of implementing standardized protocol, EHR tools, staff education, and patient engagement. This is a four-pronged strategy addressing not just the structure of communication, but culture, workflow, and patient involvement. Furthermore, in drawing in APRNs as leaders and data analysts, the project brings out the distinct value added of advanced nursing practice in advancing system-level change, a somewhat under-addressed frontier in the field of handoff studies. Additionally, by incorporating patient perspectives through bedside handoff and feedback, the project contributes to the literature on patient-centred communication, a growing but still limited body of evidence.
Implications of the Change Project
References
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related PICOT change project questions NURS 6052 EVIDENCE-BASED PROJECT, PART 3