CC BY-NC-ND 4.0 · Appl Clin Inform 2021; 12(03): 647-654
DOI: 10.1055/s-0041-1731714
Special Section on Care Transitions

A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor

Bommy Hong Mershon
1   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Andrea Vannucci
2   Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, United States
Trent Bryson
3   Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Felix Lin
4   Technical Services, Epic Systems Corporation, Verona, Wisconsin, United States
Philip E. Greilich
3   Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Guy Dear
5   Department of Anesthesiology and Pediatrics, Duke University, Durham, North Carolina, United States
Patrick Guffey
6   Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, United States
Aalok Agarwala
7   Department of Anesthesiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Funding None.


Objectives The operating room is a specialized, complex environment with many factors that can impede effective communication during transitions of care between anesthesia clinicians. We postulated that an efficient, accessible, standardized tool for intraoperative handoffs built into standard workflow would improve communication and handoff safety. Most institutions now use an electronic health record (EHR) system for patient care and have independently designed intraoperative handoff tools, but these home-grown tools are not scalable to other organizations and lack vendor-supported features. The goal of this project was to create a standardized, intraoperative handoff tool supported by EHR functionality.

Methods The Multicenter Handoff Collaborative, with support from the Anesthesia Patient Safety Foundation, created a working group of frontline anesthesia experts to collaborate with a development team from the EHR vendor (Epic Systems) to design a standardized intraoperative handoff tool. Over 2 years, the working group identified the critical elements for the tool and software usability, and the EHR team designed a standardized intraoperative handoff tool that is accessible to any institution using this EHR.

Results The first iteration of the intraoperative handoff tool was released in August 2019, with a second version in February 2020. The tool is standardized but customizable by individual institutions.

Conclusion We demonstrate that work on complex health care processes critical to patient safety, such as handoffs, can be performed on a national scale through cross-industry collaboration. Frontline experts can partner with health care industry vendors to design, build, and release a product on an accelerated timeline.

Protection of Human and Animal Subjects

No human subjects were involved in this project.

Publication History

Received: 07 January 2021

Accepted: 25 May 2021

Article published online:
28 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001
  • 2 Joint Commission Center for Transforming Healthcare releases targeted solutions tool for hand-off communications. Jt Comm Perspect 2012; 32 (08) 1
  • 3 Jurevvicz K, Alfred M, Neyens DM, Catchpole K, Joseph A, Reeves ST. Investigating intraoperative and intraprofessional handoffs in anesthesia. Proc Hum Factors Ergon Soc Annu Meet 2018; 62 (01) 469-473
  • 4 Cooper JB, Newbower RS, Long CD, McPeek B. Preventable anesthesia mishaps: a study of human factors. Anesthesiology 1978; 49 (06) 399-406
  • 5 Scoville R, Little K. Comparing Lean and Quality Improvement. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2014
  • 6 Quisenberry E. How does standard work lead to better patient safety?. Accessed June 15, 2021 at:
  • 7 Berenholtz SM, Pronovost PJ, Lipsett PA. et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004; 32 (10) 2014-2020
  • 8 Rozich JD, Howard RJ, Justeson JM, Macken PD, Lindsay ME, Resar RK. et al. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf 2004; 30 (01) 5-14
  • 9 Agarwala AV, Firth PG, Albrecht MA. et al. An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care. Anesth Analg 2015; 120 (01) 96-104
  • 10 Barbeito A, Agarwala AV, Lorinc A. Handovers in perioperative care. Anesthesiol Clin 2018; 36 (01) 87-98
  • 11 Agarwala AV, Lane-Fall MB, Greilich PE. et al. Consensus recommendations for the conduct, training, implementation, and research of perioperative handoffs. Anesth Analg 2019; 128 (05) e71-e78
  • 12 Multiple. APSF Newsletter: The Official Journal of the Anesthesia Patient Safety Foundation. Anesth. Patient Saf. Found. 2017 ; Vol. 32, No. 2, 29–56. Accessed June 15, 2021 at:
  • 13 Martinez DA, Mora E, Gemmani M, Zayas-Castro J. Uncovering hospitalists' information needs from outside healthcare facilities in the context of health information exchange using association rule learning. Appl Clin Inform 2015; 6 (04) 684-697
  • 14 Brown PJ, Marquard JL, Amster B. et al. What do physicians read (and ignore) in electronic progress notes?. Appl Clin Inform 2014; 5 (02) 430-444
  • 15 APSF. APSF's perioperative patient safety priorities. 2018 . Accessed November 12, 2020 at:
  • 16 Reames BN, Krell RW, Campbell Jr DA, Dimick JB. A checklist-based intervention to improve surgical outcomes in Michigan: evaluation of the Keystone Surgery program. JAMA Surg 2015; 150 (03) 208-215
  • 17 Haynes AB, Edmondson L, Lipsitz SR. et al. Mortality trends after a voluntary checklist-based surgical safety collaborative. Ann Surg 2017; 266 (06) 923-929