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.