Abstract
Session D presented Thursday, September 27, 2:30-3:30 pm
Purpose: There is no more vulnerable a time for a patient than during handoff and transfer from the ED to an inpatient unit. That transition is fraught with communication failures that can impact safety. But from a patient throughput perspective, hospitals and emergency departments are pressured to get patients out of the ED fast to decompress. Achieving a safe balance between these two competing concepts of outgoing and incoming patients is the challenge. Handoff is described as the transfer of patient information and knowledge, along with authority and responsibility, from one clinician or team to another. The Joint Commission (TJC) requires and the Agency for Healthcare Research and Quality (AHRQ) promotes organizations to implement a standardized approach.
Design: Using the five-step process improvement model of define, measure, analyze, improve, and control, steps were taken to improve handoff processes.
Setting: Level 1 Emergency Department, Level 1 Trauma Center in an Urban Quaternary Care Teaching Hospital with over 79,000 annual visits. Participants/Subjects: Emergency, inpatient and patient placement nurses, transporters, PI Management and Information Technology (IT) Engineers, Patient Safety Representative, admitted patients.
Methods: Barriers and inconsistencies in ED to inpatient handoff were identified. A custom nursing handoff communication tool (IT tool) was created in the EMR software to provide a standardized report to augment telephonic handoff. Using the SBAR model, the IT tool auto-populates relevant information already existing in the EMR when the bed is requested and again when assigned. All inpatient and ED nurses were educated about the IT tool prior to implementation. Emergency nurses completed a survey regarding the delays encountered before and after implementation of the IT tool. Median time from "Bed Request to Bed Assign" and "Bed Assign to Patient Depart" was measured pre and post implementation.
Results/Outcomes: The IT tool was trialed for a 90-day period to facilitate consistency of use. The emergency nurse survey before (n=107) and after (n=90) implementation revealed that prior to the IT tool, "report issue" was the most common barrier (42%). That barrier was less immediately post implementation (37%). The median time in minutes from "Bed Request to Bed Assign" and "Bed Assign to Patient Depart" was collected for 3 months prior (n=1875) and post (n=1909) implementation of the IT tool. "Bed Request to Bed Assign" increased from 72.15 to 91.3 but the median time from "Bed Assign to Patient Depart" decreased from 34.35 to 33. The increased time of "Bed Request to Bed Assign" was attributed to inpatient charge nurses having more useful data for decision-making to match patient needs with staff competency/bed type.
Implications: Programming the EMR to autopopulate an IT tool for handoff maximizes IT functionality, was easily accomplished, facilitated efficient documentation and communication at the time of admission from the ED, reduced time from "Bed Assign to Patient Depart" and was well received by the staff. More evidence is needed however to validate the effectiveness of IT tools during handoff. Related data collection to measure decline in patient status within 4 hours of admission from ED that required higher level of care is in progress.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Patient Handoff, Throughput, Emergency Department to Inpatient Unit
Recommended Citation
Carr, Meredith; Popowycz, Nicholas; Bowen, Emily; Denis, Liset; Prewitt, Judy; and White, Ann, "Using information technology to promote patient handoff, safety and throughput" (2019). General Submissions: Presenations (Oral and Poster). 148.
https://www.sigmarepository.org/gen_sub_presentations/2018/posters/148
Conference Name
Emergency Nursing 2018
Conference Host
Emergency Nurses Association
Conference Location
Pittsburgh, Pennsylvania, USA
Conference Year
2018
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Using information technology to promote patient handoff, safety and throughput
Pittsburgh, Pennsylvania, USA
Session D presented Thursday, September 27, 2:30-3:30 pm
Purpose: There is no more vulnerable a time for a patient than during handoff and transfer from the ED to an inpatient unit. That transition is fraught with communication failures that can impact safety. But from a patient throughput perspective, hospitals and emergency departments are pressured to get patients out of the ED fast to decompress. Achieving a safe balance between these two competing concepts of outgoing and incoming patients is the challenge. Handoff is described as the transfer of patient information and knowledge, along with authority and responsibility, from one clinician or team to another. The Joint Commission (TJC) requires and the Agency for Healthcare Research and Quality (AHRQ) promotes organizations to implement a standardized approach.
Design: Using the five-step process improvement model of define, measure, analyze, improve, and control, steps were taken to improve handoff processes.
Setting: Level 1 Emergency Department, Level 1 Trauma Center in an Urban Quaternary Care Teaching Hospital with over 79,000 annual visits. Participants/Subjects: Emergency, inpatient and patient placement nurses, transporters, PI Management and Information Technology (IT) Engineers, Patient Safety Representative, admitted patients.
Methods: Barriers and inconsistencies in ED to inpatient handoff were identified. A custom nursing handoff communication tool (IT tool) was created in the EMR software to provide a standardized report to augment telephonic handoff. Using the SBAR model, the IT tool auto-populates relevant information already existing in the EMR when the bed is requested and again when assigned. All inpatient and ED nurses were educated about the IT tool prior to implementation. Emergency nurses completed a survey regarding the delays encountered before and after implementation of the IT tool. Median time from "Bed Request to Bed Assign" and "Bed Assign to Patient Depart" was measured pre and post implementation.
Results/Outcomes: The IT tool was trialed for a 90-day period to facilitate consistency of use. The emergency nurse survey before (n=107) and after (n=90) implementation revealed that prior to the IT tool, "report issue" was the most common barrier (42%). That barrier was less immediately post implementation (37%). The median time in minutes from "Bed Request to Bed Assign" and "Bed Assign to Patient Depart" was collected for 3 months prior (n=1875) and post (n=1909) implementation of the IT tool. "Bed Request to Bed Assign" increased from 72.15 to 91.3 but the median time from "Bed Assign to Patient Depart" decreased from 34.35 to 33. The increased time of "Bed Request to Bed Assign" was attributed to inpatient charge nurses having more useful data for decision-making to match patient needs with staff competency/bed type.
Implications: Programming the EMR to autopopulate an IT tool for handoff maximizes IT functionality, was easily accomplished, facilitated efficient documentation and communication at the time of admission from the ED, reduced time from "Bed Assign to Patient Depart" and was well received by the staff. More evidence is needed however to validate the effectiveness of IT tools during handoff. Related data collection to measure decline in patient status within 4 hours of admission from ED that required higher level of care is in progress.