When it comes to handing off patients, mistakes are typical. Suppressing information that might lead to medical errors and patient damage is a risky practice. When there are verbal handovers, it is typical for providers to create a handoff report by hand. When data is manually input, there is a considerable risk of transcriptional errors, especially in educational institutions with students of varied capacities.
Implementation and Evaluation of a Patient Handoff Tool
Physician burnout has been minimized and patient outcomes have improved as a result of work-hour restrictions in hospitals. They have failed to produce major improvements in patient outcomes, despite obvious increases in resident well-being. Patients treated by a covering physician may experience poor outcomes if there is a lack of continuity of treatment and frequent handoffs.
By introducing handoff assistance into current speech protocols, it may be feasible to eliminate mistakes. Errors can be reduced by using an electronic health record (EHR). Data from the electronic health record is used to produce a handoff printout (EHR). One of its primary functions is to accurately transcribe drug, dose, and demographic data.
An EHR-generated Patient Handoff Tool with columns pre-populated with NICU patient data was used to improve the correctness and completeness of handoff sheets. Over the course of six months, the goal of this effort was to raise user satisfaction by 20%, reduce handoff time by 20%, and improve medication accuracy by 80%.
Significance of the Problem
Handoffs are famously difficult for humans, and not only in those instances. Consider how frequently hospitalists are required to do so through handoffs. Arpana Vidyarthi, an assistant professor of medicine at the University of California, San Francisco, estimates that her 550-bed medical center has approximately 4,000 handoffs every day. That equates to 1.5 million handoffs every year at a single site.
Another issue with handoffs is that they rarely contain a two-way data exchange. Even when there is no communication, as Dr. Arora demonstrated, it is fairly possible for the recipient to appear to be listening to the speaker.
Nodding, eye contact, and nonverbal communication are all passive listening behaviors that indicate that the speaker has not understood what has been stated. Participants are required to take notes, ask questions, and engage fully during read-back. Interruptions can stymie information transport. Contrary to popular assumption, physicians frequently interrupt themselves to participate in side conversations with colleagues.
Doctors who arrive late for handoffs and then rush through them are also a problem. This becomes an issue when physicians’ schedules do not provide adequate time for questions and responses.
Interns who received these sorts of handoffs remembered 69 percent of the if-then items and 65 percent of the to-do items.
Finding the best implementation of patient handoff tool
While a patient’s treatment team may change, the word “care transition” is usually used when discussing handoffs. Transfers between units, services, or hospitals come within this category. A handoff may send information regarding recent or anticipated changes in a patient’s health or treatment. The Joint Commission addressed patient transfer as part of its national Patient Safety Goals in 2006. The capacity to start and answer to inquiries was recognized as a required component of a systematic message transmission process.
Errors and misconceptions arise throughout the handover process. Nurses, physicians, and other support professionals are on call 24 hours a day, seven days a week at the emergency department. As a result of the frequent shift changes, patient care is uneven. Employees at the emergency department must deal with a number of interruptions, including as noise, phone calls, codes, and the arrival of emergency medical services (EMS) trucks. Even when there are no delays, handoffs are hazardous. Another common blunder is a patient’s clinical view and approach being unclear. Another significant source of inaccuracy is the recipient’s inattention or lack of focus. Handoffs are viewed differently by specialists and emergency department personnel.
Handoffs can account for up to 80% of significant medical mistakes. Incorrect handoffs account for up to 24 percent of all ED malpractice events. Guidelines for patient handoff can assist reduce medical blunders. In some cases, students may be asked to assist with organized handoff instruction.
Characteristics of Good and Poor Handoffs Communication
A good handover should be concise and thorough. Despite the difficulty, this should hold the audience’s attention throughout the presentation. It’s typical to begin with the patient’s name, age, and gender to let the listener get to know the patient. Following that, a brief history of the present ailment is collected, and systems are reviewed before doing a physical examination. Following that, any more research, expert consultation, working diagnosis, and awaiting discoveries (such as additional labs, imaging) will be carried out. Even if the conclusion is already known or predicted, communicate it anyhow. As a final resort, they should be approachable.
Despite the fact that verbal communication is still necessary, combining verbal and written handoffs resulted in an increase in recollection rates. Using the EMR as a focal point can assist in ensuring that all lab and imaging findings are addressed. An interruption may result in data inaccuracies or patient omissions.
Successful Handoff Protocol Term
Despite the fact that handoff tools exist in a variety of styles, their goal is always to increase provider-to-provider communication. Protocols are a collection of guidelines that may be applied to every discourse while speaking with others. It is anticipated that both the sender and the recipient are always aware of the communication process. It should also make it easy for individuals to ask and answer questions from one another. The ultimate aim of any patient information handoff, regardless of diversions or interruptions, should be to develop solid, face-to-face connection.
The heterogeneous team was able to complete Physician Handoff by working together. Following a series of blunders, we developed a PDSA method that includes collaborating with the IT department and EHR supplier, assigning senior residents to serve as liaisons, and including the IM leadership team.
IM The effort was monitored by departmental leadership, but issue resolution was delegated to resident liaisons and information technology. It was a leadership style that prioritized resident interaction while adhering to a specified framework. Furthermore, the department’s top administrators solicited feedback from a big number of the hospital’s attending doctors. Residents and attending physicians must collaborate to acquire and synthesize each other’s viewpoints. They communicated people’s concerns in a succinct and non-confrontational manner. Only when all three parties agreed on a modification could it be incorporated into the design of the handoff (IM, IT, and liaisons). Our information technology team assisted us in detecting technical difficulties in addition to aiding with the creation and implementation of our new handoff system. Many physicians considered them as vital members of the design team because of their innovative suggestions.
Physician Handoff’s interim medical director leadership and resident liaisons have been designated as “super users.” The super users worked together to give a thorough yet brief training session for the remaining attendees. A planned training session was held to teach I-PASS handoff ideas as well as the capabilities of the Physician Handoff application. After completing their credentialing training, resident liaisons used the I-PASS technique. The success was credited to the liaison’s perseverance and the end-users’ authentication.
The Physician Worklist is difficult to use and lacks important elements for new doctors (plan of care, disposition, and task list). Our findings are consistent with previous recent studies demonstrating the importance of incorporating end-users in the design and deployment of handoff systems [19-22]. The “Comment” and “Actions” sections were introduced to allow providers to interact on a more personal level. The Physician Handoff app revealed critical patient data. Because of the concision, there are fewer patients on each page. Physician Handoff has experienced an improvement in user satisfaction as a consequence of the incorporation of end-user feedback.