PICO(T) Evidence Review

PICO(T) Evidence Review

The Joint Commission has predicted an estimate of 80% of serious level medical errors as being associated with the miscommunication between the caregivers during hand-off among the patients. The implication of the handoff is the transfer as well as the acceptance of the responsibility for the care of the patient attainable by means of enhancing communication effectiveness (Halms, 2013). In most cases, crucial information about the care of the patient is lost during changes in shifts. There is thus a need for enhancement of the safety and quality of handoff that requires the implementation of strategies that can support that initiative (Gordon & Findley, 2011). This assignments posits to shed light on the issue of hand-off and identify potential solution through the PICO(T) question formulation. It is also prudent to make use of information technology in searching the databases that offer evidence and select the suitable evidence that support the PICO(T) question as well as a critical appraisal of the evidence. PICO(T) Evidence Review

Most facilities lack information standardization that is essential during handoff in intensive care units that translates to high degree of inaccuracy in information exchange. The situation leads to inconsistent patient care with a high degree of dissatisfaction among the patients as well as the staff responsible for the patient care. The family members of the patients can also be affected and it can be catastrophic to the patients. The Joint Commissions and the National Patient Safety Goals suggests the need for improvements in communication effectiveness among the caregivers (The Joint Commission, 2018). PICO(T) Evidence Review

The evidence search shall be guided by a PICO(T) question that is developed for the purpose of executing evidence review on the best practices that entails the adult patients who are discharged with instructions as well as follow-up post disacharge in the emergency department.

Among the adults in the intensive care unit (P), does the handoff among the nurses that incorporate the patients with the family members (I), relative to the handoff that involves the nurses only (C), leads to improved nursing and the clinician satisfaction in communication (O) during the length of stay in the ICU (T). PICO(T) Evidence Review

In the above PICO(T) question, the population, P includes the adult patients in the ICU. The intervention, I is the nursing handoff at the end of the shift that involves the patient and the family members. The standard practice –comparison is the nurse handoff report. The outcomes, O entail the enhanced collaboration of care as well as the comprehension of the patient, the patient safety as well as satisfaction. Time, T is the length of stay in the ICU.

Description of Search

The search of evidence entails the utilization of the HS/HSL instructional librarian, the faculty, the feedback from the discussion board and module 3 as the guide to the search as well as the choice of evidence. It is appropriate to account for five studies that shall contribute in responding to the PICO(T) question and four out of the total are primary sources while the rest can be secondary or even primary sources. The prospective intervention studies coupled with the randomized controlled trials can form the best and ideal primary sources and thus, they deserve to be accorded priority. The evidence review also required the use of the CINAHL and the PubMed databases in the identification of the literature that addresses the PICO(T) question. PICO(T) Evidence Review


Specifically, the following were the search terms that formed the basis of evidence search: hand-off, change of shift, patient information, care safety, nurse staff satisfaction. The access to updated data was a crucial consideration that prompted limiting of the search to recent publications, not older than 5 years (2013 – 2018) that addressed issues relating to adult populations only. There was a further restriction to the peer reviewed articles when using CINAHL and PubMed. Apart from the searches in the databases, some articles were also resourceful that were located through the background research on the topic of handoff and due to the relevance to the PICO(T) question.

It is prudent to consider placing a greater echelon of emphasis on the high-quality of the outcomes in the handoff studies that focuses on the system factors in addition to the human performance relative to the effectiveness of the structured protocols, evaluation as well as education. The current research focuses on particular departments and institutions with much of their emphasis on the convenience use of designs, samples as well as outcome measures. The starting point in the future research in handoff must be the development of the conceptual framework that places the PICOT questions within the theoretical framework on the basis of the previous evidence search. It is also suitable to isolate the articles identified through evidence search that are not particular to the items of the PICOT questions. Only the articles that address all issues as suggested in the PICOT questions can be considered for use in the research. PICO(T) Evidence Review


Benham-Hutchins, M. M., & Effken, J. A. (2010). Multi-professional patterns and methods of communication during patient handoffs. International journal of medical informatics, 79(4), 252-267.

Butcher, L. (2015). The high-stakes handoff. Trustee, 68(3), 8-10,12. Retrieved from https://search.proquest.com/docview/1667959809?accountid=45049

Gordon, M & Findley, R., (2011). Educational interventions to improve handover in health care: a systematic review. Med Educ. 45(11):1081–1089.

Halms, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161

Halms, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161 PICO(T) Evidence Review

The Joint Commission. (2018). The National Patient Safety Goals. Retrieved February 06, 2018 from http://www.jointcommission.org/standards_information/npsgs.aspx

In adult intensive care patients, does nursing hand-off that involves the patient and family member compared to hand-off that only involves nurses improve nursing or clinician satisfaction with communication?

The lack of standardization of information shared during end of shift report or “handoff” in the intensive care unit often leads to inaccurate exchange of information. Without some standardization of what are pertinent issues and significant negatives, patient care is inconsistent and the results can be dissatisfaction among patient care staff, patient family members, and at times catastrophic for the patient. This is identified by the Joint Commissions as a need for improvement nationwide on hospital inpatient. National Patient Safety Goals (NPSB) includes improving the effectiveness of communication among caregivers in 2018 (Joint Commission, 2018). Handoff is defined as the transfer and acceptance of responsibility for patient care that is achieved through effective communication (Halm, 2013). PICO(T) Evidence Review

Population (P): Adult patients in intensive care unit

Intervention ( I ): nursing handoff in patient room and involve patient and family member at the end of shift

Comparison ( C ): Standard practice – nurse hand off report at the nursing station

Outcomes ( O ): better care collaboration and comprehension of patient, patient safety and satisfaction

Time ( T ): within the length of ICU stay  PICO(T) Evidence Review


The Joint Commission. (2018). The National Patient Safety Goals. Retrieved February 06, 2018 from


Halms, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161 PICO(T) Evidence Review

Also check: Global Healthcare Comparison Matrix and Narrative Statement