Handoff strategies in settings with high consequences for failure: lessons for health care operations

Objective. To describe strategies employed during handoffs in four settings with high consequences for failure. Design. Analysis of observational data for evidence of use of 21 handoff strategies. Setting. NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto. Main measure. Evidence of 21 handoff strategies from observations and interviews. Results. Nineteen of 21 strategies were used in at least one domain, on at least an 'as needed' basis. Conclusions. An understanding of how handoffs are conducted in settings with high consequences for failure can jumpstart endeavors to modify handoffs to improve patient safety.