reports to nursing staff meetings. Several common themes ran through all of the scenarios of poor handoffs: gaps in information, lack of active listening, time wasted by different members of the health care team saying the same thing, and a lack of alignment between the ED and the inpatient care teams. A new model
The UMMC/UMACH group used the results of the focus group meetings and debriefings, in combination with the research literature and in-situ simulations, to identify core elements of effective patient care handoffs. The intervention that emerged was a scheduled conference call among nursing and physician team members caring for a patient. Specifically, the emergency room resident, and attending physician, and nurse are conferenced in with the inpatient attending physician, resident, and nurse. The patient placement manager is also on the call, to facilitate communication and help to quickly get a
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According to the Joint Commission, communication errors are the leading cause of sentinel events in hospitals. bed assigned and the patient transported. On the conference calls, the emergency room and inpatient service jointly review a high-level checklist that they jointly developed. The checklist is standardized to ensure that information is communicated in an expected order and is complete, regardless of what individual staff members are involved in the handoff. Beginning Dec. 14, 2010, the new handoff process, using the checklist and an interdisciplinary handoff via conference call, was rolled out for all pediatric units admitting patients through the emergency department. Results
Results of the implementation show that using the new handoff process improved standardization of clinical content of handoffs by 90 percent. The
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new handoff process reduced the number of handoffs from four to one while decreasing the time for the handoff by 50 percent. Extrapolating the time savings to all pediatrics emergency department admissions, we can predict a reduction of approximately 2,100 hours of clinical work spent on handoffs annually. The presence of the interdisciplinary members on the conference call has presented logistical challenges. Management of this change in process is critical because clinicians are not used to scheduling a time for ED-to-inpatient handoffs; handoffs are usually occurring when staff can fit it in between other clinical tasks. In addition, physicians are not accustomed to conducting handoffs with nursing staff present in the conversation.
Training about the process and information about the benefits to the patient are critical. Though adverse events are low in number, we are monitoring our impact on them. Our follow-up on staff perceptions of patient safety and teamwork has indicated that staff view this process as facilitating the patient experiencing improved continuity of care, and that staff from the ED and inpatient units feel more aligned. Perseverance in change management strategies such as employee sensing sessions, one-on-one meetings with leadership, and communication of progress were and continue to be critical to sustaining this project’s impact. Sommer Alexander, MS, is Lean Six Sigma Black Belt at University of Minnesota Medical Center, Fairview. Michael Aylward, MD, is assistant professor of medicine and pediatrics at the University of Minnesota Medical School, Minneapolis.
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