1
|
Muller G, Brits H. The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education. Afr J Emerg Med 2024; 14:212-217. [PMID: 39220254 PMCID: PMC11362814 DOI: 10.1016/j.afjem.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Inadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. Methods A multi-method study design was used - a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. Results HCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. Conclusion This study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.
Collapse
Affiliation(s)
- George Muller
- Division of Health Sciences Education, University of the Free State, Bloemfontein, South Africa
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Hanneke Brits
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
2
|
Franco Vega MC, Ait Aiss M, George M, Day L, Mbadugha A, Owens K, Sweeney C, Chau S, Escalante C, Bodurka DC. Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center. Jt Comm J Qual Patient Saf 2024; 50:560-568. [PMID: 38584053 DOI: 10.1016/j.jcjq.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Communication failures are among the most common causes of harmful medical errors. At one Comprehensive Cancer Center, patient handoffs varied among services. The authors describe the implementation and results of an organization-wide project to improve handoffs and implement an evidence-based handoff tool across all inpatient services. METHODS The research team created a task force composed of members from 22 hospital services-advanced practice providers (APPs), trainees, some faculty members, electronic health record (EHR) staff, education and training specialists, and nocturnal providers. Over two years, the task force expanded to include consulting services and Anesthesiology. Factors contributing to ineffective handoffs were identified and organized into categories. The EHR I-PASS tool was used to standardize handoff documentation. Training was provided to staff on its use, and compliance was monitored using a customized dashboard. I-PASS champions in each service were responsible for the rollout of I-PASS in their respective services. The data were reported quarterly to the Quality Assessment and Performance Improvement (QAPI) governing committee. Provider handoff perception was assessed through the biennial Institution-wide safety culture survey. RESULTS All fellows, residents, APPs, and physician assistants were trained in the use of I-PASS, either online or in person. Adherence to the I-PASS written tool improved from 41.6% in 2019 to 70.5% in 2022 (p < 0.05), with improvements seen in most services. The frequency of updating I-PASS elements and the action list in the handoff tool also increased over time. The handoff favorability score on the safety culture survey improved from 38% in 2018 to 59% in 2022. CONCLUSION The implementation approach developed by the Provider Handoff Task Force led to increased use of the I-PASS EHR tool and improved safety culture survey handoff favorability.
Collapse
|
3
|
Angah N, Meedzan B, Pruzinsky N, O'Connell A, Hart L, Cobbs-Lomax D, Vanderwoude P. Leveraging Technology and Workflow Optimization for Health-Related Social Needs Screening: An Improvement Project at a Large Health System. Jt Comm J Qual Patient Saf 2024; 50:24-33. [PMID: 38087722 DOI: 10.1016/j.jcjq.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The collection of health-related social needs (HRSN) data at one large health system has historically been inconsistent. This project was aimed to increase annual HRSN screening rates by standardizing data collection in the electronic health record (EHR) through optimized clinical workflows. METHODS The authors designed a standard screening questionnaire in alignment with the Accountable Health Communities model, and they conducted interviews with eleven US-based health systems and one medical center on best practices for ambulatory HRSN screening and interventions, which identified five possible methods to administer the questionnaire. After testing, the authors opted to send questionnaires to patients through the patient portal three days prior to an ambulatory visit. For inpatients, in-person interviews were implemented. Staff implementing the updated processes included registered nurses, social workers, preventive health coordinators, and community health workers. RESULTS The annual screening rate for all active ambulatory patients increased from 0.4% to 15.9% (p < 0.001), and 10.7% of all patients had at least one health-related social need. The annual screening rate for inpatients was estimated to be zero at baseline and increased by 66 percentage points (p < 0.001). The most prevalent health-related social need in both settings was financial resource strain, followed closely by food insecurity. CONCLUSION Well-designed interventions and technology support were effective in achieving improved screening and data collection. Leadership support, building interventions within preexisting workflows, and ensuring standard data capture in the EHR were key factors leading to successful process improvement.
Collapse
|
4
|
Ryan SL, Logan M, Liu X, Shahian DM, Mort E. Long-Term Sustainability and Adaptation of I-PASS Handovers. Jt Comm J Qual Patient Saf 2023; 49:689-697. [PMID: 37648628 DOI: 10.1016/j.jcjq.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Inadequate communication during transitions of care is a major health care quality and safety vulnerability. In 2013 Massachusetts General Hospital (MGH) embarked on a comprehensive training program using a standardized handover system (I-PASS) that had been shown to reduce adverse events by 30% even when not completely executed on each patient. In this cross-sectional study, the authors sought to characterize handover practices six years later. METHODS Using a standardized interview tool, the researchers evaluated handovers between responding clinicians in 10 departments and then validated these findings through direct observations, allowing for flexibility and customization in the I-PASS elements. The study qualitatively compared I-PASS element use in verbal handovers to MGH early postintervention data, as well as verbal and written handovers with the I-PASS Study Group's postintervention results. RESULTS The authors observed 156 verbal and reviewed 182 written patient handovers. Ninety percent of departments adhered at least partially to the I-PASS system. Average handover duration ranged from 0.6 to 2.1 minutes per established patient. The service with best I-PASS adherence also consistently included the most information per unit of time. Acknowledging substantial differences in study technique, MGH adherence was, on average, comparable or better on all I-PASS elements in verbal handovers and on three of four elements of written handovers compared with the I-PASS Study Group's postintervention results. CONCLUSION Although uptake has varied across services, six years after hospitalwide implementation of I-PASS, the majority of services are performing structured and sequenced handovers, most of which include some elements of the I-PASS system. Those services with the best I-PASS adherence conducted the most efficient handovers.
Collapse
|
5
|
Lightsey HM, Yeung CM, Rossi LP, Chen AF, Harris MB, Stenquist DS. OrthoPass: Long-term Outcomes following Implementation of an Orthopaedic Patient Handoff Template. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00002. [PMID: 38011052 PMCID: PMC10664846 DOI: 10.5435/jaaosglobal-d-23-00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/29/2023]
Abstract
Standardized handoff tools improve communication and patient care; however, their widespread use in surgical fields is lacking. OrthoPass, an orthopaedic adaptation of I-PASS, was developed in 2019 to address handoff concerns and demonstrated sustained improvements across multiple handoff domains over an 18-month period. We sought to characterize the longitudinal effect and sustainability of OrthoPass within a single large residency program 3.5 years after its implementation. This mixed methods study involved electronic handoff review for quality domains in addition to survey distribution and evaluation. We conducted comparative analyses of handoff adherence and survey questions as well as a thematic analysis of provider-free responses. We evaluated 146 electronic handoffs orthopaedic residents, fellows, and advanced practice providers 3.5 years after OrthoPass implementation. Compared with 18-month levels, adherence was sustained across five of nine handoff domains and was markedly improved in two domains. Furthermore, provider valuations of OrthoPass improved regarding promoting communication and patient safety (83% versus 70%) and avoiding patient errors and near misses (72% versus 60%). These improvements were further substantiated by positive trends in Agency for Healthcare Research and Quality Surveys on Patient Safety Culture hospital survey data. Thematic analysis of free responses shared by 37 providers (42%) generated favorable, unfavorable, and balanced themes further contextualized by subthemes. At 3.5 years after its introduction, OrthoPass continues to improve patient handoff quality and to support provider notions of patient safety. Although providers acknowledged the benefits of this electronic handoff tool, they also shared unique insights into several drawbacks. This feedback will inform ongoing efforts to improve OrthoPass.
Collapse
Affiliation(s)
- Harry M. Lightsey
- From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen)
| | - Caleb M. Yeung
- From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen)
| | - Laura P. Rossi
- From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen)
| | - Antonia F. Chen
- From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen)
| | - Mitchel B. Harris
- From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen)
| | - Derek S. Stenquist
- From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen)
| |
Collapse
|
6
|
Ahlness EA, Molloy-Paolillo BK, Brunner J, Cutrona SL, Kim B, Matteau E, Rinne ST, Walton E, Wong E, Sayre G. Impacts of an Electronic Health Record Transition on Veterans Health Administration Health Professions Trainee Experience. J Gen Intern Med 2023; 38:1031-1039. [PMID: 37798576 PMCID: PMC10593679 DOI: 10.1007/s11606-023-08283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adoption of electronic health care records (EHRs) has proliferated since 2000. While EHR transitions are widely understood to be disruptive, little attention has been paid to their effect on health professions trainees' (HPTs) ability to learn and conduct work. Veterans Health Administration's (VA) massive transition from its homegrown EHR (CPRS/Vista) to the commercial Oracle Cerner presents an unparalleled-in-scope opportunity to gain insight on trainee work functions and their ability to obtain requisite experience during transitions. OBJECTIVE To identify how an organizational EHR transition affected HPT work and learning at the third VA go-live site. DESIGN A formative mixed-method evaluation of HPT experiences with VHA's EHR transition including interviews with HPTs and supervisors at Chalmers P. Wylie VA Outpatient Clinic in Columbus, OH, before (~60 min), during (15-30 min), and after (~60 min) go-live (December 2021-July 2022). We also conducted pre- (March 2022-April 2022) and post-go live (May 2022-June 2022) HPT and employee surveys. PARTICIPANTS We conducted 24 interviews with HPTs (n=4), site leaders (n=2), and academic affiliates (n=2) using snowball sampling. We recruited HPTs in pre- (n=13) and post-go-live (n=10) surveys and employees in pre- (n=408) and post-go-live (n=458) surveys. APPROACH We conducted interviews using a semi-structured guide and grounded prompts. We coded interviews and survey free text data using a priori and emergent codes, subsequently conducting thematic analysis. We conducted descriptive statistical analysis of survey responses and merged interview and survey data streams. KEY RESULTS Our preliminary findings indicate that the EHR transition comprehensively affected HPT experiences, disrupting processes from onboarding and training to clinical care contributions and training-to-career retention. CONCLUSIONS Understanding HPTs' challenges during EHR transitions is critical to effective training. Mitigating the identified barriers to HPT training and providing patient care may lessen their dissatisfaction and ensure quality patient care during EHR transitions.
Collapse
Affiliation(s)
- Ellen A Ahlness
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA.
| | - Brianne K Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care, Los Angeles, CA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Erin Matteau
- VA Office of Academic Affiliations, Washington, DC, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- The Pulmonary Center, Department of Medicine, Boston University, Boston, MA, USA
| | - Edward Walton
- VA Office of Academic Affiliations, Washington, DC, USA
| | - Edwin Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| | - George Sayre
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| |
Collapse
|
7
|
Mahoney RC, Goto D, Erol HA, Sheu J, Chen YA, Morrison B, Cryer C, Murayama KM. Measuring the Impact of a Formalized Surgical Patient Signout System. JOURNAL OF SURGICAL EDUCATION 2023; 80:1150-1157. [PMID: 37391306 DOI: 10.1016/j.jsurg.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE Routine patient signout within medical teams is an integral component of patient care. Standardized signout systems have shown lowered risks of harm and adverse outcomes to patients, however, many of these systems are difficult to utilize with surgical patients. The purpose of this study was to determine if a standardized surgical signout model would improve resident satisfaction of the signout process and improve resident preparedness for cross-covered services. DESIGN A 16-question survey was administered to the surgical residents at a single general surgery residency program. A standardized signout using the mnemonic "CUTS" (Core problem, Updates, Things-to-do, Setbacks) was then implemented in the program. Residents retook the survey at 1, 3, and 6-month intervals to compare resident satisfaction on signout before and after the standardized signout implementation. The descriptive statistics of the survey were analyzed for trends over time, trends by resident training year, and for inferential statistics utilizing subscales. RESULTS The descriptive statistics showed that there was an overall trend towards greater resident satisfaction with signout over time with satisfaction increasing from 41.1% to 80% in the general resident cohort. While there were no statistically significant differences, subscale analysis demonstrated greatest trends for improved satisfaction with the CUTS signout model for the PGY1 and PGY5 classes. There was additionally an increased resident preparedness for overnight events and calls, with a 27% increase in perceived preparedness "75% of the time" and a 5.5% increase in perceived preparedness "Always". There was no difference in time spent on signout after the implementation of the model. CONCLUSIONS The surgical standardized signout model, CUTS, demonstrated that residents within a single program were more satisfied with signouts, had improved patient understanding and knowledge, and felt increased preparedness for overnight events on cross-covered patients. Further research is needed to determine the impact of the CUTS signout system on patient outcomes.
Collapse
Affiliation(s)
- Reid C Mahoney
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Dylan Goto
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - H Akin Erol
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
| | - Jonathan Sheu
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Yj Alexis Chen
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Breanna Morrison
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Chad Cryer
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Kenric M Murayama
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| |
Collapse
|
8
|
Paquette S, Kilcullen M, Hoffman O, Hernandez J, Mehta A, Salas E, Greilich PE. Handoffs and the challenges to implementing teamwork training in the perioperative environment. Front Psychol 2023; 14:1187262. [PMID: 37397334 PMCID: PMC10310998 DOI: 10.3389/fpsyg.2023.1187262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.
Collapse
Affiliation(s)
- Shannon Paquette
- Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
| | - Molly Kilcullen
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Olivia Hoffman
- Division of Critical Care Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jessica Hernandez
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ankeeta Mehta
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Philip E. Greilich
- Department of Anesthesiology and Pain Management, Health System Chief Quality Office, Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
9
|
Starmer AJ, Michael MM, Spector ND, Riesenberg LA. Improving Handoffs in the Perioperative Environment: A Conceptual Framework of Key Theories, System Factors, Methods, and Core Interventions to Ensure Success. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00130-7. [PMID: 37423813 DOI: 10.1016/j.jcjq.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events. CONCEPTUAL FRAMEWORK The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ. IMPLICATIONS Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.
Collapse
|
10
|
Yanni E, Calaman S, Wiener E, Fine JS, Sagalowsky ST. Implementation of ED I-PASS as a Standardized Handoff Tool in the Pediatric Emergency Department. J Healthc Qual 2023; 45:140-147. [PMID: 37141571 DOI: 10.1097/jhq.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Communication, failures during patient handoffs are a significant cause of medical error. There is a paucity of data on standardized handoff tools for intershift transitions of care in pediatric emergency medicine (PEM). The purpose of this quality improvement (QI) initiative was to improve handoffs between PEM attending physicians (i.e., supervising physicians ultimately responsible for patient care) through the implementation of a modified I-PASS tool (ED I-PASS). Our aims were to: (1) increase the proportion of physicians using ED I-PASS by two-thirds and (2) decrease the proportion reporting information loss during shift change by one-third, over a 6-month period. METHODS After literature and stakeholder review, Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) was implemented using iterative Plan-Do-Study-Act cycles, incorporating: trained "super-users"; print and electronic cognitive support tools; direct observation; and general and targeted feedback. Implementation occurred from September to April of 2021, during the height of the COVID-19 pandemic, when patient volumes were significantly lower than prepandemic levels. Data from observed handoffs were collected for process outcomes. Surveys regarding handoff practices were distributed before and after ED I-PASS implementation. RESULTS 82.8% of participants completed follow-up surveys, and 69.6% of PEM physicians were observed performing a handoff. Use of ED I-PASS increased from 7.1% to 87.5% ( p < .001) and the reported perceived loss of important patient information during transitions of care decreased 50%, from 75.0% to 37.5% ( p = .02). Most (76.0%) participants reported satisfaction with ED I-PASS, despite half citing a perceived increase in handoff length. 54.2% reported a concurrent increase in written handoff documentation during the intervention. CONCLUSION ED I-PASS can be successfully implemented among attending physicians in the pediatric emergency department setting. Its use resulted in significant decreases in reported perceived loss of patient information during intershift handoffs.
Collapse
|
11
|
Starmer AJ, Spector ND, O’Toole JK, Bismilla Z, Calaman S, Campos ML, Coffey M, Destino LA, Everhart JL, Goldstein J, Graham DA, Hepps JH, Howell EE, Kuzma N, Maynard G, Melvin P, Patel SJ, Popa A, Rosenbluth G, Schnipper JL, Sectish TC, Srivastava R, West DC, Yu CE, Landrigan CP. Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. J Hosp Med 2023; 18:5-14. [PMID: 36326255 PMCID: PMC10964397 DOI: 10.1002/jhm.12979] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. OBJECTIVE To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. DESIGN Prospective Type 2 Hybrid effectiveness implementation study. SETTINGS AND PARTICIPANTS Residents from diverse specialties across 32 hospitals (12 community, 20 academic). INTERVENTION External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. MAIN OUTCOME AND MEASURES Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. RESULTS 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p < .05) and 17.5 to 9.3 minor events/person-year (p < .001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p < .001, n = 4812) and written (10% vs. 74%, p < .001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p < .001) and written (29% vs. 78%, p < .001) patient summaries, verbal (29% vs. 78%, p < .001) and written (24% vs. 73%, p < .001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p < .001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).
Collapse
Affiliation(s)
- Amy J. Starmer
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy D. Spector
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics and Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer K. O’Toole
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zia Bismilla
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Calaman
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Maria-Lucia Campos
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maitreya Coffey
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lauren A. Destino
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Jennifer L. Everhart
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Jenna Goldstein
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Dionne A. Graham
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jennifer H. Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eric E. Howell
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas Kuzma
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Greg Maynard
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Patrice Melvin
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Shilpa J. Patel
- Department of Pediatrics, Kapi’olani Medical Center for Women and Children/University of Hawai’i John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Alina Popa
- Department of Medicine, University of California Riverside, Riverside, California, USA
- Division of Hospital Medicine, University of California San Diego, San Diego, California, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, California, USA
| | - Jeffrey L. Schnipper
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore C. Sectish
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Daniel C. West
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clifton E. Yu
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher P. Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
12
|
Riesenberg LA, Davis R, Heng A, Vong do Rosario C, O'Hagan EC, Lane-Fall M. Anesthesiology Patient Handoff Education Interventions: A Systematic Review. Jt Comm J Qual Patient Saf 2022:S1553-7250(22)00296-3. [PMID: 36631352 DOI: 10.1016/j.jcjq.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anesthesiology provider handoffs are complex, occur frequently, and have been associated with adverse patient outcomes. The authors sought to determine the degree to which anesthesiology handoff studies with educational interventions incorporated tenets of educational best practices. METHODS The research team conducted a systematic review of the peer-reviewed literature focused on handoff studies with education interventions that included anesthesiology providers. Searches were conducted using PubMed, Embase, Scopus, Cochrane, and ERIC (2010-September 2021). Each phase of the article review process included at least two trained independent reviewers. In addition, pairs of trained reviewers abstracted study characteristics RESULTS: Twenty-six articles met inclusion criteria. Two thirds (18/26; 69.2%) were published after 2017, and almost three fourths (19/26; 73.1%) included learners. Education intervention descriptions varied, with only 15.4% (4/26) briefly mentioning education theory, 7.7% (2/26) with clear education objectives, and 7.7% (2/26) assessing curriculum via participant satisfaction. Most (22/26; 84.6%) assessed Kirkpatrick's level 3 (handoff behavior change), and 26.9% (7/26) assessed level 4b (patient outcomes). Medical education quality scores were low (range 6-24, mean 11.3; max 32), with more than half (15/26; 57.7%) receiving scores ≤ 10. CONCLUSION Educational interventions demonstrate marked heterogeneity in the use of educational theoretical concepts and established curriculum development best practices. Future studies should report on important aspects of educational interventions, which would allow for comparison across studies, yield the essential data needed to identify handoff education best practices, and improve patient safety.
Collapse
|
13
|
Stenquist DS, Yeung CM, Szapary HJ, Rossi L, Chen AF, Harris MB. Sustained Improvement in Quality of Patient Handoffs After Orthopaedic Surgery I-PASS Intervention. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00002. [PMID: 36067218 PMCID: PMC9447790 DOI: 10.5435/jaaosglobal-d-22-00079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE The I-PASS tool has been shown to decrease medical errors in patient handoffs in nonorthopaedic surgery fields. We prospectively studied the implementation of a version of this handoff tool modified for orthopaedic surgery patients in an academic practice at two level I trauma centers. METHODS This was a prospective study of a multicenter handoff improvement program. Handoffs were evaluated preintervention and at 1, 6, 9, and 18 months postintervention for key data elements defined by I-PASS. Rates of adverse clinical outcomes were compared before and after the handoff intervention. RESULTS Seven hundred five electronic patient handoffs were analyzed. From preintervention to the 18-month time point, notable improvement was observed in 8 of 9 targeted quality elements. In Poisson regression analysis, adherence to the standardized handoff format was sustained at markedly improved levels throughout all postintervention time points. No statistically significant differences were observed between rates of 30-day readmission, 90-day readmission, urinary tract infection, pulmonary embolism/deep vein thrombosis, surgical site infection, or delirium before and after the intervention. CONCLUSION Introduction of an orthopaedic-specific I-PASS tool produced sustained adherence from a group of over 50 orthopaedic providers. Objective quality of handoffs improved markedly as defined by the I-PASS standard, and 86% of the providers supported the ongoing use of the tool. Despite the improvement in handoff quality, we were unable to demonstrate a notable change in measured clinical outcomes. Methods for the development and implementation of the orthopaedic-specific I-PASS tool are described. Orthopaedic residency programs should consider using a version of I-PASS to standardize care.
Collapse
Affiliation(s)
- Derek S Stenquist
- From the Harvard Combined Orthopaedic Residency Program, Boston, MA (Dr. Stenquist, Dr. Yeung); the Harvard Medical School, Boston, MA (Szapary); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Rossi, Dr. Harris); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Chen)
| | | | | | | | | | | |
Collapse
|
14
|
Huang Y, Alkhalfan F, Kim H, Alzedaneen Y, Haleem Z, Zhou M, Sood A, Chow RD. The Impact of Electronic Handoff Tool on Sign-Out Practices in an Internal Medicine Residency Program. Am J Med Qual 2022; 37:290-298. [PMID: 35213861 DOI: 10.1097/jmq.0000000000000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
High-quality and efficient sign-outs are essential to ensure patient safety. To evaluate the impact of a new handoff tool by objective measures of handoff quality and residents' subjective experiences. Internal medicine residents working on a medical ward service completed a handoff clinical evaluation exercise (CEX) questionnaire and an anonymous survey on handoff quality and experiences prior to implementing a new handoff tool and at 2 and 6 weeks after implementation. CEX scores significantly improved from 5.3 ± 1.1 to 6.9 ± 0.7 in 6 weeks ( P < 0.05). Residents reported that they were contacted less frequently after work, information needed by the receiving resident was more often found in the sign-out, and that tasks signed out to the oncoming team were more often executed. Before implementing the new handoff tool, 87% of residents reported that they were contacted after work hours 1-2 times per week with questions, while 75% of participants reported that they were almost never contacted after work hours after the new tool was implemented. A standardized handoff tool that utilizes smart phrases to provide residents with templates for sign-out significantly improved the quality and experience of sign-out in a short time period.
Collapse
Affiliation(s)
- Yuting Huang
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Fahad Alkhalfan
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Harim Kim
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Yazan Alzedaneen
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Zarah Haleem
- American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
| | - Meng Zhou
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Aseem Sood
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Robert D Chow
- University of Maryland Medical Center Midtown Campus, Baltimore, MD
| |
Collapse
|
15
|
Kothari SY, Haynes SC, Sigal I, Magana JN, Ruttan T, Kuppermann N, Horeczko T, Ludwig L, Karsteadt L, Chapman W, Pinette V, Marcin JP. Resources for Improving Pediatric Readiness and Quality of Care in Rural Communities and Emergency Departments. Pediatr Emerg Care 2022; 38:e1069-e1074. [PMID: 35226633 DOI: 10.1097/pec.0000000000002658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To share the process and products of an 8-year, federally funded grant from the Health Resources and Services Administration Emergency Medical Services for Children program to increase pediatric emergency readiness and quality of care provided in rural communities located within 2 underserved local emergency medical services agencies (LEMSAs) in Northern California. METHODS In 2 multicounty LEMSAs with 24 receiving hospital emergency departments, we conducted focus groups and interviews with patients and parents, first responders, receiving hospital personnel, and other community stakeholders. From this, we (a regional, urban children's hospital) provided a variety of resources for improving the regionalization and quality of pediatric emergency care provided by prehospital providers and healthcare staff at receiving hospitals in these rural LEMSAs. RESULTS From this project, we provided resources that included regularly scheduled pediatric-specific training and education programs, pediatric-specific quality improvement initiatives, expansion of telemedicine services, and cultural competency training. We also enhanced community engagement and investment in pediatric readiness. CONCLUSIONS The resources we provided from our regional, urban children's hospital to 2 rural LEMSAs facilitated improvements in a regionalized system of care for critically ill and injured children. Our shared resources framework can be adapted by other regional children's hospitals to increase readiness and quality of pediatric emergency care in rural and underserved communities and LEMSAs.
Collapse
Affiliation(s)
| | | | | | - Julia N Magana
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | - Timothy Horeczko
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Lorah Ludwig
- Emergency Medical Services for Children, Division of Child, Adolescent, and Family Health, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD
| | | | | | - Vickie Pinette
- Sierra-Sacramento Valley Emergency Medical Services, Rocklin, CA
| | | |
Collapse
|
16
|
Effect of a Multispecialty Faculty Handoff Initiative on Safety Culture and Handoff Quality. Pediatr Qual Saf 2022; 7:e539. [PMID: 35369417 PMCID: PMC8970093 DOI: 10.1097/pq9.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022] Open
Abstract
Structured handoffs at transitions of care are vital components of patient safety. A safety culture survey showed that “handoffs and transitions” were among the lowest scoring dimensions at our hospital. We sought to improve physician handoffs and safety culture scores by implementing standardized handoff communication across multiple divisions of an academic pediatric department.
Collapse
|
17
|
Humphrey KE, Sundberg M, Milliren CE, Graham DA, Landrigan CP. Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims. J Patient Saf 2022; 18:130-137. [PMID: 35188927 DOI: 10.1097/pts.0000000000000937] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Joint Commission has identified miscommunication as a leading cause of sentinel events, the most serious adverse events, but it is unclear what role miscommunications play in malpractice claims. We sought to determine the proportion of medical malpractice claims involving communication failure and describe their nature, including providers involved, locations, miscommunications types, costs, and the potential for handoff tools to avert risk and associated costs. METHODS We retrospectively reviewed a random sample of malpractice claims from 2001 to 2011, collected in CRICO Strategies' Comparative Benchmarking System, a national claims database. Two researchers reviewed cases to determine if a claim involved communication failure, its type, and potential preventability using a communication tool. Interrater reliability was assessed by dual review of 50 cases (81% agreement, κ = 0.62 for evidence of miscommunication). Claimant demographics, case characteristics, and financial data were analyzed. RESULTS Communication failures were identified in 49% of claims. Claims with communication failures were significantly less likely to be dropped, denied, or dismissed than claims without (54% versus 67%, P = 0.015). Fifty-three percent of claims with communication failures involved provider-patient miscommunication, and 47% involved provider-provider miscommunication. The information types most frequently miscommunicated were contingency plans, diagnosis, and illness severity. Forty percent of communication failures involved a failed handoff; the majority could potentially have been averted by using a handoff tool (77%). Mean total costs for cases involving communication failures were higher ($237,600 versus $154,100, P = 0.005). CONCLUSIONS Communication failures are a significant contributing cause of malpractice claims and impose a substantial financial burden on the healthcare system. Interventions to improve transmission of critical patient information have the potential to substantially reduce malpractice expenditures.
Collapse
|
18
|
Gungor S, Akcoban S, Tosun B. Evaluation of emergency service nurses' patient handover and affecting factors: A descriptive study. Int Emerg Nurs 2022; 61:101154. [PMID: 35176658 DOI: 10.1016/j.ienj.2022.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/05/2022]
Abstract
AIM The aim of the study was to determine the patient handover efficacy level of emergency room nurses and the influencing factors. METHOD This descriptive, cross-sectional study was completed with (n = 120) emergency room nurses of two different state hospitals from April 26 to May 26, 2021. The "Nurses descriptive information form" and "Handover Evaluation Scale" were used as data collection forms. RESULTS The mean age of the nurses was 29.53(6.327 years, 70.8% of them were female, and 76.7% of them had a bachelor's degree. The mean number of handovers was 3.25 (SD = 3.17) for one nurse in a shift, and the mean handover duration for a patient was 10.16 (SD = 9.23) minutes. More than half of the nurses (61.7%) carried out oral handover at the bedside. The mean score of the handover evaluation scale was 53.31 (SD = 9.55). The mean score of the nurses who performed the handover with all the nurses on the shift (spelling and relieving) together was 56.47 (SD = 9.21) and higher than that of the nurses who performed the handover in small groups 49.84 (SD = 9.70), (p = 0.012). CONCLUSION The results of this study may contribute to promoting patient safety and improving patient handover processes in emergency rooms. It is recommended that standardized and comprehensive written handover forms be used, that all emergency room nurses should attend the handover process, and that further observational and interventional studies should be conducted.
Collapse
Affiliation(s)
- Serap Gungor
- Kahramanmaras Sutcu Imam University, Vocational School of Health Services, Kahramanmaras, Turkey.
| | - Sumeyye Akcoban
- Mustafa Kemal University, Kırıkhan Vocational School, Health Services Department Hatay, Turkey
| | - Betul Tosun
- Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey
| |
Collapse
|
19
|
Lafontaine J, Casacalenda N, Perreault M, Laliberté V, Milton D. Improving Transfer of Care Between Psychiatrists and Residents: Participants' Perspective on the Implementation of a Handover Protocol in a Psychiatric Emergency. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:114-119. [PMID: 33973167 DOI: 10.1007/s40596-021-01472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Handover refers to the transfer of information from one professional to another during transitions of care. I-PASS is a mnemonic tool which stands for Illness severity; Patient summary; Action list; Situation awareness and contingency planning; and Synthesis by receiver. It was developed to standardize the handover process. Psychiatrists, nurses, and residents at the Montreal Jewish General Hospital psychiatric emergency were trained and the I-PASS handover model was implemented. METHODS Thirty-one psychiatrists, nurses, and residents participated in this quality improvement project. Participants filled a pre-training questionnaire to examine the baseline status of handovers before attending a training session on I-PASS. Participants then filled a second questionnaire assessing the perceived quality of the handover training session, as well as anticipated benefits and challenges of I-PASS prior to its implementation. Finally, following implementation, two focus groups were held to collect feedback from participants. RESULTS Pre-training, most participants reported that information provided during handovers was incomplete. Training was overall much appreciated. The most significant anticipated obstacle for implementing I-PASS was lack of time to properly fill out the form. Post-implementation, participants unanimously reported an improvement in the handover process. Handovers were perceived as faster, providing all key information about patients, and the perceived quality of the information was better. CONCLUSION Overall, the implementation of the I-PASS handover model was much appreciated by participants, who perceived that handovers were more comprehensive, efficient, and of better quality.
Collapse
Affiliation(s)
- Jonathan Lafontaine
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Nicola Casacalenda
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Michel Perreault
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Vincent Laliberté
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Diana Milton
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| |
Collapse
|
20
|
Michael MM, Ambardekar AP, Pukenas E, Karamchandani K, Nguyen H, Potestio CP, Tubinis MD, Huang NR, Riesenberg LA. Enablers and Barriers to Multicenter Perioperative Handoff Collaboration: Lessons Learned From a Successful Model Outside the Operating Room. Anesth Analg 2021; 133:1358-1363. [PMID: 34673728 DOI: 10.1213/ane.0000000000005724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Meghan M Michael
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erin Pukenas
- Department of Anesthesiology, Cooper Medical School at Rowan University, Camden, New Jersey
| | - Kunal Karamchandani
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Huong Nguyen
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher P Potestio
- Department of Anesthesiology, Cooper Medical School at Rowan University, Camden, New Jersey
| | - Michelle D Tubinis
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Norman R Huang
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lee Ann Riesenberg
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
21
|
Burke RE, Marang-van de Mheen PJ. Sustaining quality improvement efforts: emerging principles and practice. BMJ Qual Saf 2021; 30:848-852. [PMID: 34001651 DOI: 10.1136/bmjqs-2021-013016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Robert E Burke
- Section of Hospital Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA .,Center for Health Equity Research and Promotion (CHERP), Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsyllvania, Philadelphia, PA, USA
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands
| |
Collapse
|
22
|
Abstract
BACKGROUND Communication failures, including clinical handoff or clinical handover errors, contribute to 80% of all serious preventable adverse events each year. The N-PAS, N = Nurse, P = Patient Summary, A = Action Plan, and S = Synthesis, is a flexible standardized clinical handoff tool for nurses. PURPOSE The purpose of this study was to determine the proportion of N-PAS core components present in real-world patient handoffs. METHODS A mixed-methods design was used to analyze secondary data. Patient handoffs (n = 138) were transcribed into statements and then independently coded by 2 research assistants. RESULTS Of all handoff statements, 63.2% were coded as Patient Summary and 13.6% were coded as Action Plan, whereas Synthesis was not coded in any handoffs. Three new Patient Summary elements and 1 new Action Plan element were identified. CONCLUSION Patient Summary and Action Plan are critical data reported during clinical handoff. A handoff synthesis is a critical step to include in handoff training.
Collapse
|
23
|
Jorro-Barón F, Suarez-Anzorena I, Burgos-Pratx R, De Maio N, Penazzi M, Rodriguez AP, Rodriguez G, Velardez D, Gibbons L, Ábalos S, Lardone S, Gallagher R, Olivieri J, Rodriguez R, Vassallo JC, Landry LM, García-Elorrio E. Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial. BMJ Qual Saf 2021; 30:782-791. [PMID: 33893213 DOI: 10.1136/bmjqs-2020-012370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes' effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs). METHODS Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation. RESULTS We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5-97.4) vs intervention 60.4 (33.2-109.9), p=0.99, risk ratio: 1.0 (0.74-1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6-41.8) vs intervention 34.7 min (26.5-42.1); difference 1.43 min (95% CI -2.63 to 5.49, p=0.49)). The providers' perception of improved communication did not change. CONCLUSIONS After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs' frequency or the perception of enhanced communication. TRIAL REGISTRATION NUMBER NCT03924570.
Collapse
Affiliation(s)
- Facundo Jorro-Barón
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina .,PICU, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Inés Suarez-Anzorena
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Rodrigo Burgos-Pratx
- PICU, Hospital Materno Infantil 'Héctor Quintana', San Salvador de Jujuy, Jujuy, Argentina
| | - Noelia De Maio
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Matías Penazzi
- PICU, Hospital de Niños de San Justo, San Justo, Provincia de Buenos Aires, Argentina
| | | | - Gisela Rodriguez
- PICU, El Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Daniel Velardez
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Luz Gibbons
- Statistics, Data Management and Information Systems, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Silvina Ábalos
- PICU, Hospital Materno Infantil 'Héctor Quintana', San Salvador de Jujuy, Jujuy, Argentina
| | - Silvina Lardone
- PICU, Hospital de Niños de San Justo, San Justo, Provincia de Buenos Aires, Argentina
| | - Rosario Gallagher
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Joaquín Olivieri
- PICU, El Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Rocío Rodriguez
- Statistics, Data Management and Information Systems, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Juan Carlos Vassallo
- Teaching and Research, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Luis Martín Landry
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | | |
Collapse
|
24
|
Shahian D. I-PASS handover system: a decade of evidence demands action. BMJ Qual Saf 2021; 30:769-774. [PMID: 33893212 DOI: 10.1136/bmjqs-2021-013314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David Shahian
- Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
25
|
Appelbaum R, Martin S, Tinkoff G, Pascual JL, Gandhi RR. Eastern association for the surgery of trauma - quality, patient safety, and outcomes committee - transitions of care: healthcare handoffs in trauma. Am J Surg 2021; 222:521-528. [PMID: 33558061 DOI: 10.1016/j.amjsurg.2021.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Handoffs are defined as the transfer of patient information, professional responsibility, and accountability between caregivers. This work aims to clarify the current state of transitions of care related to the management of trauma patients. METHODS A PubMed database and web search were performed for articles published between 2000 and 2020 related to handoffs and transitions of care. The key search terms used were: handoff(s), handoff(s) AND healthcare, and handoff(s) AND trauma. A total of 55 studies were included in qualitative synthesis. RESULTS This systematic review explores the current state of healthcare handoffs for trauma patients. Factors found to impact successful handoffs included process standardization, team member accountability, effective communication, and the incorporation of culture. This review was limited by the small number of prospective randomized studies available on the topic. CONCLUSION Handoffs in trauma care have been studied and should be utilized in the context of published experience and practice. Standardization when applied with accountability has proven benefit to reduce communication errors during these transfers of care.
Collapse
Affiliation(s)
- Rachel Appelbaum
- Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Shayn Martin
- Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Glen Tinkoff
- Department of Surgery, University Hospitals, Cleveland, OH, USA.
| | - Jose L Pascual
- Surgery/Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rajesh R Gandhi
- Department of Surgery, JPS Health Network, Medical Education, TCU/UNTHSC School of Medicine, Fort Worth, TX, USA.
| |
Collapse
|
26
|
Jorro Barón F, Pumara CD, Tittarelli MAJ, Raimondo A, Urtasun M, Valentini L. Improved handoff quality and reduction in adverse events following implementation of a Spanish-language version of the I-PASS bundle for pediatric hospitalized patients in Argentina. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043520961708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction communication errors between medical personnel are known to be a leading source of adverse events (AEs). The implementation of teamwork training together with the use of a standardized handoff bundle has previously shown to reduce the number of AEs. However, the applicability of this program in spanish-speaker countries remains unclear. Objective to assess whether the exploratory implementation of I-PASS bundle in an Argentine pediatric hospital is associated with a reduction in the rate of AEs. Methods Design: an exploratory, uncontrolled, pre-post study. Population and sample: medical records (MR), medical prescriptions, and physician reports were reviewed in two clinical wards of the "Hospital General de Niños Pedro de Elizalde". Intervention: I-PASS Spanish version, an standardized handoff bundle consists in: a mnemonics, an introductory workshop, a written handoff tool, simulation sessions, and structured observations with feedback. Results we reviewed 264 MR. Preventable AEs decreased by 62.8% between pre-intervention and post-intervention period (12.1 vs 4.5 AEs/100 admissions; IC95: 0.010; 0.142; [p = 0.025]). Adherence to the use of quality handoff key elements increased significantly, from 25% to 61% in post-intervention period (p = 0.0001). Handoff duration did not change significantly (5.5 ± 0.2 vs 5.3 ± 0.3 minutes per patient [p = 0.59]). Conclusion Implementation of an I-PASS Spanish version was associated with a significant reduction in the rate of AEs and with improvements in handoff quality; without changes in duration.
Collapse
Affiliation(s)
- Facundo Jorro Barón
- Pediatric Intensive Care Unit, Hospital General de Niños “Pedro de Elizalde”, Buenos Aires, Argentina
| | - Celina Diaz Pumara
- Education and Research, Hospital General de Niños “Pedro de Elizalde”, Buenos Aires, Argentina
| | | | - Agustina Raimondo
- Education and Research, Hospital General de Niños “Pedro de Elizalde”, Buenos Aires, Argentina
| | - Marcela Urtasun
- Education and Research, Hospital General de Niños “Pedro de Elizalde”, Buenos Aires, Argentina
| | - Lucila Valentini
- Education and Research, Hospital General de Niños “Pedro de Elizalde”, Buenos Aires, Argentina
| |
Collapse
|
27
|
Soberano BT, Brady P, Yunger T, Jones R, Stoneman E, Sosa T, Stalets EL, Zackoff M, Chima R, Tegtmeyer K, Dewan M. The Effects of Care Team Roles on Situation Awareness in the Pediatric Intensive Care Unit: A Prospective Cross-Sectional Study. J Hosp Med 2020; 15:594-597. [PMID: 32853138 PMCID: PMC7850634 DOI: 10.12788/jhm.3449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/17/2020] [Indexed: 11/20/2022]
Abstract
Improved situation awareness (SA) decreases rates of clinical deterioration in the pediatric inpatient setting. We used a prospective, cross-sectional, observational study to measure interprofessional care team SA for a pediatric intensive care unit (PICU) patients. The resident, bedside nurse, and respiratory therapist for each patient were surveyed regarding high clinical deterioration risk status as defined by clinical criteria identified by the PICU fellow or attending and mitigation plan. From March 2018 to July 2019, we surveyed 400 care team trios caring for 73 high-risk patients. Nurses identified the patient's risk status correctly for 375 of 400 patients (94%), respiratory therapists, 380 (95%; P = .4), and residents, 349 (87%; P = .002). For the 73 high-risk patients, nurses were correct 82% of the time, respiratory therapists, 85%, P = .7, and residents, 67%, P = .04. Interventions targeting resident SA are needed within the PICU, especially for high-risk patients.
Collapse
Affiliation(s)
- Blaise T Soberano
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick Brady
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Toni Yunger
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rhonda Jones
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Erin Stoneman
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tina Sosa
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Erika L Stalets
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew Zackoff
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ranjit Chima
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ken Tegtmeyer
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maya Dewan
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Maya Dewan, MD, MPH; ; Telephone: 215-756-7060; Twitter: @mommimaya
| |
Collapse
|
28
|
Carr C, Hardy J, Scharf B, Levy M. Emergency Clinician Experiences Using a Standardized Communication Tool for Cardiac Arrest. Cureus 2020; 12:e9759. [PMID: 32944473 PMCID: PMC7489792 DOI: 10.7759/cureus.9759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Sudden cardiac arrest remains a common and critical disease burden. As post-cardiac arrest care grows in complexity, communication between pre-hospital providers, emergency department personnel, and hospital consultants is increasingly important. Methods This study evaluated the use of a standard handoff tool between pre-hospital personnel and hospital staff, including emergency medical services (EMS), emergency department nurses, physicians, and cardiologists. Personnel were surveyed regarding attitudes surrounding the important aspects of cardiac arrest care, challenges faced, and preference of handoff mechanism. Results Most of the survey respondents (58, 76%) found that the initial rhythm was the most important factor in post-cardiac arrest care, followed by the presence of bystander cardiopulmonary resuscitation (CPR; 55, 72%) and the presence of ST-elevation on initial electrocardiogram (46, 61%). Both emergency physicians (7, 63%), as well as cardiologists (3, 100%), preferred to have this tool performed over radio prior to arrival in the emergency department. Conclusion The importance given to various post-cardiac arrest factors varied amongst specialty and clinical background; however, all agreed on common features such as the initial rhythm, electrocardiogram (ECG) morphology, and the presence or absence of bystander CPR. Additionally, the timing and structure of how this information is delivered were further elucidated. This data will guide future handoff methods between specialties managing patients after cardiac arrest.
Collapse
Affiliation(s)
- Casey Carr
- Department of Emergency Medicine, University of Florida - Shands, Gainesville, USA
| | - Joshua Hardy
- School of Medicine, Georgetown University, District of Columbia, USA
| | - Becca Scharf
- Department of Fire and Rescue Services, Howard County Department of Fire and Rescue Services, Marriottsville, USA
| | - Matthew Levy
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,Office of the Medical Director, Howard County Department of Fire and Rescue Services, Marriottsville, USA
| |
Collapse
|
29
|
Blazin LJ, Sitthi-Amorn J, Hoffman JM, Burlison JD. Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings. Pediatr Qual Saf 2020; 5:e323. [PMID: 32766496 PMCID: PMC7382547 DOI: 10.1097/pq9.0000000000000323] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Communication failures are common root causes of serious medical errors. Standardized, structured handoffs improve communication and patient safety. I-PASS is a handoff program that decreases medical errors and preventable patient harm. The I-PASS mnemonic is defined as illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver. I-PASS was validated for physician handoffs, yet has the potential for broader application. The objectives of this quality improvement initiative were to adapt and implement I-PASS to handoff contexts throughout a pediatric hospital, including those with little or no known evidence of using I-PASS. METHODS We adapted and implemented I-PASS for inpatient nursing bedside report, physician handoff, and imaging/procedures handoff. Throughout the initiative, end-user stakeholders participated as team members and informed the adaptation of the I-PASS mnemonic, handoff processes, written handoff documents, and performance evaluation methods. Peers observed handoffs, scored performance, and provided formative feedback. Adherence to I-PASS was the primary outcome. We also evaluated changes in handoff-related error frequency and clinician attitudes about the effects of I-PASS on personal and overall handoff performance. RESULTS All 5 elements of the I-PASS mnemonic were used in 87% of inpatient nursing, 76% of physician, and 89% of imaging/procedures handoffs. Inpatient nurses reported reductions in handoff-related errors following I-PASS implementation. Clinicians across most handoff settings reported that using I-PASS improved both general and personal handoff performance. CONCLUSIONS I-PASS is adaptable to many handoff settings, which expands its potential to improve patient safety. Clinicians reported reductions in errors and improvements in handoff performance. We identified broad institutional support, customized written handoff documents, and peer observations with feedback as crucial factors in sustaining I-PASS usage.
Collapse
Affiliation(s)
- Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jitsuda Sitthi-Amorn
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
- Hospitalist Program, St. Jude Children's Research Hospital, Memphis, TN
| | - James M Hoffman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis TN
| | - Jonathan D Burlison
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
30
|
Bøje RB, Ludvigsen MS. Non-formal patient handover education for healthcare professionals: a scoping review. JBI Evid Synth 2020; 18:952-985. [DOI: 10.11124/jbisrir-d-19-00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
31
|
Moore W, Doshi A, Gyftopoulos S, Bhattacharji P, Rosenkrantz AB, Kang SK, Recht M. Enhancing communication in radiology using a hybrid computer-human based system. Clin Imaging 2020; 61:95-98. [PMID: 32004954 DOI: 10.1016/j.clinimag.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Communication and physician burn out are major issues within Radiology. This study is designed to determine the utilization and cost benefit of a hybrid computer/human communication tool to aid in relay of clinically important imaging findings. MATERIAL AND METHODS Analysis of the total number of tickets, (requests for assistance) placed, the type of ticket and the turn-around time was performed. Cost analysis of a hybrid computer/human communication tool over a one-year period was based on human costs as a multiple of the time to close the ticket. Additionally, we surveyed a cohort of radiologists to determine their use of and satisfaction with this system. RESULTS 14,911 tickets were placed in the 6-month period, of which 11,401 (76.4%) were requests to "Get the Referring clinician on the phone." The mean time to resolution (TTR) of these tickets was 35.3 (±17.4) minutes. Ninety percent (72/80) of radiologists reported being able to interpret a new imaging study instead of waiting to communicate results for the earlier study, compared to 50% previously. 87.5% of radiologists reported being able to read more cases after this system was introduced. The cost analysis showed a cost savings of up to $101.12 per ticket based on the length of time that the ticket took to close and the total number of placed tickets. CONCLUSIONS A computer/human communication tool can be translated to significant time savings and potentially increasing productivity of radiologists. Additionally, the system may have a cost savings by freeing the radiologist from tracking down referring clinicians prior to communicating findings.
Collapse
Affiliation(s)
- William Moore
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America.
| | - Ankur Doshi
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Soterios Gyftopoulos
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Priya Bhattacharji
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Andrew B Rosenkrantz
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Stella K Kang
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Michael Recht
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| |
Collapse
|
32
|
Addition of CORES to the I-PASS Handoff: A Resident-led Quality Improvement Study. Pediatr Qual Saf 2020; 5:e251. [PMID: 32190796 PMCID: PMC7056293 DOI: 10.1097/pq9.0000000000000251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 12/18/2019] [Indexed: 11/27/2022] Open
Abstract
Quality patient handoff is vital in patient care and attainable with structured handoff systems, such as the I-PASS mnemonic. This paper describes a continuous quality improvement study occurring after the implementation of the I-PASS handoff bundle. Our objectives were to (1) determine compliance with the inclusion of I-PASS elements during handoff and (2) determine whether the addition of CORES, an electronic tool that generates a patient list designed for use with I-PASS, would improve compliance and sustainability.
Collapse
|
33
|
Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
Collapse
Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
| |
Collapse
|
34
|
Trivedi S, Dick A, Beckett S, Hartmann RJ, Roberts C, Lyster K, Stempien J. An Assessment of Handover Culture and Preferred Information in the Transitions of Care of Elderly Patients. Cureus 2019; 11:e5267. [PMID: 31576260 PMCID: PMC6764648 DOI: 10.7759/cureus.5267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Transitions of care for elderly patients in long term care (LTC) to the emergency department (ED) is fraught with communication challenges. Information preferred during these transitions has not been agreed upon. We sought to understand our local handover culture and identify what information is preferred in the transitions of care of these patients. Methods We performed a cross-sectional electronic survey that was distributed to 1470 healthcare providers (HCPs) and 82 patient and family advocates (PFAs) in two Canadian cities. The HCP group consisted of physicians and nurses in ED and LTC settings as well as paramedics. The survey was open for a period of one month with formal reminders sent weekly. Results A total of 12.9% of HCPs and 26.8% of PFAs responded to the survey. Only 41.3% of HCP respondents were aware of existing handover protocols and 83.2% indicated a desire for a single page handover form. HCPs identified concerns over handover culture surrounding workplace inefficiencies and increased demands to their time. Several preferred items of information in the transitions of care for the institutionalized elderly patient were also identified across both HCP and PFA groups. Conclusions Our study identified a need for improved local handover culture in transitions of care for the institutionalized elderly patient. We also identified the preferred elements of information during bilateral communication between LTC and the ED. Our results will be used to design a patient-centred handover form for future use in this population.
Collapse
Affiliation(s)
- Sachin Trivedi
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Alixe Dick
- Emergency Medicine, University of Saskatchewan, Regina, CAN
| | | | | | | | - Kish Lyster
- Internal Medicine, Regina Qu'appelle Health Region, Regina, CAN
| | - James Stempien
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| |
Collapse
|
35
|
Mueller BU, Neuspiel DR, Fisher ERS, Franklin W, Adirim T, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Quinonez RA, Rinke ML, Shiffman RN, Saarel EV, Tieder JS, Yin HS, Phillips SC, Quinonez R, Brown JM, Walsh KM, Jewell J, Ernst K, Hill VL, Lam V, Vinocur C, Rauch D, Hsu B. Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics 2019; 143:peds.2018-3649. [PMID: 30670581 DOI: 10.1542/peds.2018-3649] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."
Collapse
Affiliation(s)
- Brigitta U. Mueller
- Johns Hopkins All Children’s Hospital, St Petersburg, Florida
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Erin R. Stucky Fisher
- Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Zipursky JS. I-CATCH: A Novel Bundle to Improve Postcall Morning Handoffs. J Grad Med Educ 2018; 10:702-706. [PMID: 30619533 PMCID: PMC6314354 DOI: 10.4300/jgme-d-18-00178.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/02/2018] [Accepted: 10/15/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Conducting postcall morning handoffs using a resident handoff bundle such as I-PASS can prove challenging. This may delay recognizing and acting on clinically important patient issues that arose overnight. OBJECTIVE We developed and implemented the I-CATCH morning handoff bundle and evaluated its impact on the proportion of overnight patient issues handed off from the on-call resident to the daytime team. METHODS We evaluated the I-CATCH (Identify patient; Characterize situation; Action-what was done overnight?; To do for the team in the morning; Confirm the Handoff) handoff bundle from November 2015 to May 2016 on general internal medicine wards at 1 academic teaching hospital. The bundle entailed staff/resident training, structured communication, and dedicated handoff space and time. We compared handoffs of overnight on-call issues by evening resident to daytime medical team before and after implementation, and used statistical process control to analyze adherence to the mnemonic. RESULTS We observed 435 handoffs (242 pre- and 193 postimplementation) over 63 days. There was no significant association between I-CATCH implementation and proportion of on-call overnight issues handed off (OR = 0.96; 95% confidence interval [CI] 0.52-1.47; P = .85). Running the list by going through patients one-by-one (OR = 1.74; 95% CI 1.1-2.77; P = .019), progress note documentation (OR = 3.80; 95% CI 2.19-6.60; P < .001), and direct handoff (OR = 4.84; 95% CI 1.43-16.42; P = .011) correlated with an increased likelihood of morning handoff. CONCLUSIONS Implementing the I-CATCH bundle did not improve handoff of overnight issues to the daytime team.
Collapse
|
37
|
Thaeter L, Schröder H, Henze L, Butte J, Henn P, Rossaint R, Sopka S. Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany. BMJ Open 2018; 8:e021202. [PMID: 30209154 PMCID: PMC6144335 DOI: 10.1136/bmjopen-2017-021202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students' awareness, confidence and knowledge regarding handover. DESIGN A controlled educational research study. SETTING The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. PARTICIPANTS A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). OUTCOME MEASURES Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. RESULTS Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. CONCLUSION We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.
Collapse
Affiliation(s)
- Laura Thaeter
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Hanna Schröder
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Lina Henze
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jennifer Butte
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Patrick Henn
- School of Medicine, University College Cork, Cork, Ireland
| | - Rolf Rossaint
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Saša Sopka
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
38
|
Abstract
Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system.
Collapse
Affiliation(s)
- Philip E Greilich
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Mary Eleanor Phelps
- Office of the Associate Dean for Quality, Safety, and Outcomes Education, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - William Daniel
- Office of the Executive Vice President for Health System Affairs, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| |
Collapse
|
39
|
|
40
|
|