Speakers
Description
Background:
Transfer of Accountability/Transfer of Information (TOA/TOI) is the exchange of patient information, responsibility, and accountability between healthcare providers during care transitions. Communication failures are well documented as sources of preventable harm, underscoring the need for standardized, high-quality TOA. In 2025, patient safety incidents identified local practice gaps and the need for audits. Aligned with Registered Nurses’ Association of Ontario’s (RNAO) best practice guideline Transitions in Care and Services, this initiative emphasized structured communication, shared accountability, and patient-centred care.
Purpose:
To evaluate TOA practices among nursing and respiratory therapists during shift change using a structured audits to identify strengths, practice gaps, and opportunities to improve patient safety.
Methods:
In February 2026, a gap analysis using RNAO’s Knowledge-To-Action Framework informed the implementation of structured TOA audits across 54 inpatient units, engaging managers, educators, and point-of-care staff. A six-item audit tool assessed consent, bedside TOA, patient/family engagement, use of SBAR (Situation-Background-Assessment-Recommendations), timeliness, and reciprocal clarification; an additional item captured TOA beyond shift end. Auditors observed nursing or respiratory therapist handover at shift change, provided real-time feedback, and recorded data using Microsoft Forms. Units aimed to complete 10 audits within one month, supported by education and resource materials.
Results:
Average audit score was 4/5, indicating strong practice standards adherence and minor improvement opportunities. Overall, 84% of TOAs included consent; 75% occurred at bedside; 60% engaged patient/family; 88% used SBAR; and 97% included reciprocal questioning. Key enablers were informed consent, patient/family engagement, bedside safety checks, and active provider dialogue. Barriers included patient-related factors and staff punctuality at shift change.
Lesson Learned & Implications for Practice:
Routine TOA auditing strengthens communication, accountability, and patient safety. Audit findings established an organizational baseline to guide ongoing quality improvement, including TOA champions, enhanced digital audit tools, and continued evaluation to support continuity of care and reduce preventable harm.
Author(s) Credentials and Title
Louisa Tam, BSc, BHScOT, OT Reg. (Ont.), Professional Practice Consultant; Joseph Pasia, RN, Clinical Educator (Renal Program); Erin Donnelly, RN, Clinical Informatics Practice Leader; Dr. Kevin Gitau, MD, Associate General Internist, Quality Improvement Physician Lead
What RNAO BPG or tool/toolkit is your abstract related to?
Knowledge-To-Action Framework
| Organization Name | Trillium Health Partners |
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