Accreditation

Baton transfer aids hospital hand-offs

Briefings on The Joint Commission, February 1, 2006

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New technique helps meet new JCAHO goal

Complying with a new National Patient Safety Goal may be as simple as passing the baton.

The Defense Department develop ed a mnemonic known as "I PASS the BATON" to comply with JCAHO goal 2E, which requires organizations to implement a standardized approach to hand-off communication between caregivers and provide an opportunity to ask and respond to questions. The requirement took effect January 1.

The mnemonic incorporates principles that many in healthcare may already recognize, including some from the familiar SBAR ( s ituation, b ackground, a ssessment, r ecommendation) technique. Another take on SBAR is I-SBAR, in which the I stands for "introduction."

SBAR was developed originally for use in the armed forces, not healthcare, says John Webster, MD, MBA, a Defense Department consultant. The department teaches SBAR and uses it for passing action-oriented critical information (e.g., on rapid response teams) and for any clinical update communication.

But SBAR doesn't always address every important part of a successful hand-off.

"It became clear that I-SBAR needed to be expanded to about eight things," Webster says. "You can miss some of the pieces that fall under the S, the B, the A, and the R."

Incorporate healthcare issues

The challenge was to develop a hand-off technique for healthcare within a six-month time frame, because the JCAHO mandated a January 1 implementation deadline for the new goal. Webster and others at the Defense Department spent about eight weeks reviewing literature about hand-offs and human factors in high-reliability organizations, malpractice lawsuits, root-cause analyses, and sentinel events to determine the best starting point.

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