Transferring Patients to a Higher Level of Care From an Ambulatory Setting

Purpose:
To investigate barriers to effective handoffs, as well as develop and implement evidence-based guidelines and an electronic Situation Background Assessment and Recommendation (SBAR) tool for patients transferring from ambulatory clinics.

Relevance/Significance:
Patient handoffs are improved by implementing standards and practices. There is limited research discussing handoffs in the ambulatory areas, with the exception of the emergency departments to inpatient units. This lack of research is problematic, considering the number of patients who are treated in ambulatory clinics and procedural areas need transfers to areas in which they can receive a higher level of care. A clinical handoff is required in order for these patients to transfer safely.

Strategy and Implementation:
A multidisciplinary workgroup investigated barriers to effective communication, developed a guideline, and an eSBAR. An aggressive education plan led to an awareness of the guideline and high competency rates through meetings with stakeholders, workgroups to develop tool and guidelines, as well as training and monitoring of implementation.

Evaluation:
145 patients were transferred from ambulatory clinics during the initial 30 days of implementation. Nurses documented on the SBAR for 84.1% of transfers, verbal handoff occurred for 62% of transfers, and documentation of transfer occurred for 68.3%. Documentation of all three components was 70%. No reports of ineffective handoffs were reported.

Implications for Practice:
Involving the interdisciplinary team in developing guidelines and standard tools supported effective implementation of strategies for patients' safe handoffs. Providing an electronic modality and resources for nurses from different areas to solve communication issues may increase patient safety.