Improving Asynchronous Handoff Communication by Implementing an Electronic Handoff Documentation Tool
AuthorMeek, Rachel M.
MetadataShow full item record
Other TitlesImplementation of an Electronic Handoff Tool
AbstractProblem: 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.
primary care handoff
Electronic Health Records
Emergency Service, Hospital
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/18851
Showing items related by title, author, creator and subject.
Exploration of Handoffs during Transitions of Care Involving Intensive Care Unit Patients: An Integrative ReviewBest, Nakia; Travers, Debbie; Kitzmiller, Rebecca Rutherford; Zomorodi, Meg (2016-07-22)
Moving from Paper to Computer: A Shift Handoff FormatChristensen, Patricia (2014)Shift handoff is an integral component of the communication process used to transfer information about patients among providers as the information conveyed during this exchange is essential to the nursing decisions, activities and interventions that take place in the care of the patient (Alvarado, et. al., 2006). When critical information is not transmitted between providers, the patient may be placed at risk for errors or omissions in care (Sand-Jecklin & Sherman, 2012). Research supports that the use of a standardized shift handoff format can enhance the shift handoff communication (Adamski, 2007) by ensuring that critical patient information is reliably transferred. Anthony and Preuss (2002) assert that the use of computerized formats in the shift handoff process can contribute to safer patient care and should be utilized to their fullest capacity. There is agreement in the literature that a standardized shift handoff format enhances patient safety, and that a computerized format best facilitates a shift handoff that has current, complete and consistent patient information (Randell et al., 2011). The purpose of this quality improvement project was to answer the question: Does an educational intervention, focused on best practices for use of a computerized shift handoff format, improve its rating of usability among nurses on a medical/surgical unit? A one group, pre- and post-test, non-experimental design was used to compare the ratings of usability before and after an education program regarding best practices for using the computerized format. An adapted System Usability Scale (Brooke, 1986), with five additional questions related to the nurse’s opinions about technology, was used for both the pre- test and the post-test. A paired-sample t-test was conducted to evaluate the impact of the education intervention on the nurses’ scores on the adapted SUS. While there was not a statistically significant difference in SUS scores between the pre-test (M = 67.67, SD = 17.42) and the post-test (M = 69.50, SD = 17.75), t (29) = -.93, p > .05 (two tailed) MOVING FROM PAPER TO COMPUTER 3 following an educational intervention, opinions did emerge related to the issue of work flow and the use of a computerized shift handoff format. Future quality improvement projects may be generated on the basis of these findings.
Implementation of a Handoff Report Tool Among Trauma Intermediate Care NursesFortune, Shanna; Bundy, Elaine Y. (2020-05)Problem and Purpose: An estimated 80% of serious errors and sentinel events are attributable to miscommunication during patient handoffs. Since 2010, the JCAHO has required that during transitions in care, healthcare providers engage in handoff communication between the giver and receiver of hospitalized patients. Inadequate patient handoff communication remains a key contributor to medical errors, preventable adverse events, and sentinel events. The illness severity, patient summary, action list, situational awareness and contingency planning, and synthesis by receiver (I-PASS) method was created with use of a tool to improve handoff communication practices. The handoff tool was designed to decrease medication errors and enhance the safety and quality of patient care. Among nurses working in a multi-trauma intermediate care unit, a standardized patient handoff process with the critical elements of communication was lacking at a tertiary academic hospital in the Mid-Atlantic region. The nurse manager of a trauma intermediate care unit reported large nursing staff turnover and concerns about novice staff members’ handoff communication effectiveness. With high acuity and a complex patient population, effective handoff is essential to maintaining patient safety as well as minimizing omissions in care and potential errors. Methods: The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate the I-PASS handoff tool for perceived handoff report communication among nurses. Compliance with the verbal communication and written report tools were audited weekly. A pre/post perceived handoff communication survey was also distributed prior to and after the 15-week project period. Results: Findings indicated that staff compliance with the I-PASS handoff report tool reached or exceeded the goal of 75% from week five to week 14. When using the handoff report tool, perceived handoff communication increased significantly by 9% post implementation (p < 0.05). The medication error event rate declined by 47% during the implementation period. Conclusions: The I-PASS handoff report tool improved perceived handoff communication among nurses. Subsequent quality improvement projects are recommended to evaluate the use of adapted unit-specific I-PASS handoff report tools to further validate the method’s effectiveness and potential to improve medication-related and patient safety events.