Purpose

Improvement Tools/Methods

Limitations / Lessons Learned

Results

Process Improvement

Improving Admission Nursing HandoffKayla Cormier, Kimberly Cremerius, and Melissa Lowe

To facilitate accurate, efficient, and complete handoff reporting when admitting patients from the Emergency Department, ED, to 3North, 3N.

To improve the continuity of care provided to patients admitted through the ED to 3N.

To improve communication and understanding among floors about handoff process and policy.

“80% of serious medical errors involve miscommunication during the handoff between medical providers” (Joint Commission Center for Transforming Healthcare, 2013).

After implementation of standardized handoff forms, Joint Commission Center for Transforming Healthcare CO reports a 56% reduction in percentage of defective handoffs for the receiver (2013).

3 North Safety Attitudes Questionnaire Plus (2013). Results. Of the Registered Nurses on 3N:Only 19% disagreed or strongly disagreed that

Hospital units do not coordinate well with each other and that things “fall between the cracks” when transferring patients from one unit to another

Only 33% disagreed or strongly disagreed that important patient care information is often lost during shift changes.

Only 38% disagreed or strongly disagreed that problems often occur in the exchange of information across hospital units.

This indicates that handoff communication was the least positive result for the floor and it is a highlight for potential improvement projects.

Nurses on the floor report being concerned that inaccurate and/or incomplete handoff reports are received from the Emergency Department.

This inconsistency in handoff reporting can lead to a decrease in quality patient care, nurse satisfaction, cause concern for patient safety, and decrease the time available for the nurse to spend at the bedside.

(Florida Hospital Tampa 3 North, 2013)

The current Electronic Medical Record, EMR, lacks a dedicated tool to support patient handoff.

Computerized patient handoff applications can be developed which when tested in other hospitals increased accuracy and completeness of handoff reporting (Wayne et. Al), decreased the amount of time required for patient handover (Vawdrey et. Al), and increased continuity of care in all included studies.

Additionally, the study completed by Vawdrey et. al demonstrated that without any special teaching, the hospital achieved widespread voluntary use, 50% of the users were nurses, 40% physicians, and 10% allied health. In addition they extended the use of their program to nearby facilities using the same EMR system.

Implement process through SHARE acronym: Standardize content, Hardwire within system, Allow questions, Reinforce quality, Educate (Joint Commission Center for Transforming Healthcare, 2013).

While specific prompting from an electronic patient handoff application is useful to decrease errors and omissions during patient transfers, it is only beneficial if it is accepted and used by those transferring patients. However if the application contains useful information without the nurse having to search through multiple areas of the EMR compliance would likely be voluntary.

In addition, it would require time and resource allocation to create and integrate into the electronic medical record.

Florida Hospital Tampa

This problem is being evaluated using a cause and effect fishbone diagram (see diagram 1).

In addition there will be a collegial meeting between 3N and the ED at the beginning and end of the project to evaluate the results.

ReferencesCollins, S. A., Stein, D. M., Vawdrey, D. K., Stetson, P. D., & Bakken, S. (2011). Content overlap in

nurse and physician handoff artifacts and the potential role of electronic health records: A systematic review. J Biomed Inform, 44(4), 704-712. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119775/

Florida Hospital Tampa 3 North. (2013). Safety Attitudes Questionnaire Plus. Tampa, FL.Hilligoss, B. & Zheng, K. (2012). Chart biopsy: An emerging medical practice enabled by electronic

health records and its impacts on emergency department-inpatient admission handoffs. Journal of the American Medical Informatics Association, 20(2), 260-267. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638186/

Joint Commission Center for Transforming Healthcare. (2013). Improving transitions of care: Hand-off communications. Retrieved from http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_Hand-off_commun_set_final_2010.pdf

Maughan, B. C., Lei, L., & Cydulka, R. K. (2011). ED handoffs: Observed practices and communication errors. The American Journal of Emergency Medicine, 29(5). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20825820

Raptis, D. A, Fernandes, C., Chua, W., & Boulos, P. B. (2009). Electronic software significantly improves quality of handover in a london teaching hospital. Health Informatics Journal, 15. Retrieved from http://jhi.sagepub.com/content/15/3/191.long

Vawdrey, D. K., Stein, D. M., Fred, M. R., Bostwick, S. B., & Stetson, P. D. (2013). Implementation of a computerized patient handoff application. AMIA Annual Symposium Proceedings Archive, 2013. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900153/

Wayne, J. D., Tyagi, R., Reinhardt, G., Rooney, D., Makoul, G., Chopra, S., & DaRosa, D. A. (2008). Simple standardized patient handoff system that increases accuracy and completeness. Journal of Surgical Education, 65(6), 476-485. Retrieved from http://www.sciencedirect.com/science/article/pii/S1931720408001864

Background

Measures

This project will be evaluated usingData from the Safety Attitudes

Questionnaire (SAQ),ED Transfer Communication Log which

includes a three question survey regarding transfer communication completed pre and post intervention (results pending), and;

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25

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35

40Safety Attitudes Questionnaire 2013

3 North

Results based on front line caregiver responses on 3 North.

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