Utilization of the EHR to ensure safe patient hand-offs

Purpose:
The Institute for Healthcare Innovation has identified handoffs as a potential safety gap and created this as a national patient goal. We wanted to use our Electronic Health Record (EHR) to create a single form for patient handoffs. To do this we involved staff from many areas in a 3 phase project.

Significance:
Thousands of hand-offs occur daily in a 550 bed tertiary care hospital so the risk of error is great. Our EHR had the capability of generating 3 transfer reports, but none was adequate for all units. The only standards for handoff are from the American Society of Post Anesthesia Nursing (ASPAN).

Strategy and Implementation:
A team of 18 nurses from various units and informatics specialists were tasked with the goal of a single handoff form, based on ASPAN guidelines. The team devised strategies, revised existing tools, and sought feedback through house wide staff surveys at multiple times during this 3 Phase year long project. Phase 1 determined baseline operations and assessed baseline RN knowledge of ability to the use the EHR for handoffs. Phase 2 used the results to design online education to improve use of the EHR and resurvey staff. Phase 3 incorporated all prior feedback, ASPAN guidelines for transfers, in order to redesign and test the EHR with end users. Finally a single report was developed and implemented for all transfers. The final survey focused on RN satisfaction with the EHR changes and uses. Results were reviewed for the entire sample (n=510) representing 29 units and then for the subset of those who were from work flow groups that were primarily receiving units and from sending units.

Evaluation:
Final survey results were: EHR improved (87.5%) ability to prepare for unit arrival; ER wait decreased by 50%; 77.6% said the handoff report was easy to use, clear & concise (74%); and 80% found it beneficial for patient care. Patient satisfaction improved; medication error rate trending downward.

Implications for Practice:
The single EHR was adopted for all patient transfers. Staff engagement ensured success of the project. Additionally, 33% of nurses used the EHR form frequently for shift report. The goal of improving patient safety through effective handoffs was achieved and additional uses for the form were found.