Improving Asynchronous Handoff Communication by Implementing an Electronic Handoff Documentation Tool

Abstract

Problem: Miscommunication during provider handoffs is linked to negative impacts on patient care, delays in treatment, inappropriate treatment, and increased lengths of stay. Prior to implementation there was no standardized handoff tool in the electronic health record (EHR). Only 4% of patients referred to the Emergency Department (ED) by their primary care team had any documentation of a handoff in the EHR. Purpose: This quality improvement project aimed to improve pre-arrival information documentation and implement and evaluate the effectiveness of an electronic documentation tool on clinician handoff documentation compliance. Methods: The ED Expected Patient Admission form was developed in the EHR for primary care clinicians to document handoff information. The form automatically created an expected patient on the ED track board view with links to pertinent information when the form is complete. ED providers could select a patient to review the handoff in a side-by-side view on the track board. This view created an ED summary for the ED provider that included previous ED visits, clinic referral summary, active patient FYIs, and other essential details. This workflow was communicated broadly to providers at the pilot sites; coaches and nurses were trained to use the form to support the new workflow. Results: There was broad acceptance and use of the new tool by primary care clinicians as evidence by attaining the target of 100% prior to goal date. Hospitalizations following the referral were reduced from a baseline of 50% to 28.5%. Referring clinicians felt they were able to communicate patient needs and felt safe using the form instead of giving traditional verbal handoff. Conclusions: This tool supported documentation compliance and asynchronous communication through standardized documentation and referral guidelines.