Using electronic nursing handoff to improve timeliness of clinical information exchange and reduce boarding time for admitted patients in the emergency department
Linda Huffman, DNP, RN; Margie Burnett, MS, RN, CNRN; Donna Beitler, MS, RN-BC; Keisha N. Perrin, BSN, RN; Candice M. Zabko, MSN, RN, NE_BC; Ashley Del Pilar, MS, RN; Heather Gardner, MSN, RN; Cindy Rutledge, MSN, RN; Hetal Rupani, MHA; Radhika B. Mehta, MHA, MPH; Barbara Maliszewski, MS, RN, NEA-BC
- Sigma Affiliation
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Top Visiting Cities
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Huffman, Linda by View
Popular Works for Huffman, Linda by Download
Session C presented Thursday, September 27, 1:00-2:00 pm
Purpose: Boarding patients in the Emergency Department (ED) can heighten risk for higher morbidity and mortality, and longer length of stay. ED boarding is a function of system inefficiencies that can cause patient outflow obstruction and is associated with inferior patient outcomes. Current average nursing hand-off time between ED and Medicine nursing units is 50 to 60 minutes. Waiting to give verbal report contributes to 8% of total boarding time and 14% of total process time. The purpose of this pilot was to reduce nursing hand-off time to less than 30 minutes by using an electronic hand-off process for nursing report from the ED to the accepting in-patient unit.
Design: We performed a quality improvement pilot project. Setting: The project took place in an urban academic level 1 trauma center with approximately 70,000 ED visits per year with a 25% admission rate.
Participants/Subjects: This project included nursing hand-off for all patients being admitted from the Emergency Department to one of two designated medical in-patient units. Due to initial successes, the pilot was expanded to four additional medical, surgical and neurology floors. Methods: We formed a central steering committee to review current ED boarding times and create dashboards and safety metrics to evaluate the pilot project. E-handoff was than validate with end-user and built into the electronic health record. Staff were educated via “fast facts” and workflow algorithm. Continuous quality assurance occurred throughout the intervention. Continuous data collection occurred via 24-hour delay dashboards and included unit-specific time measures from “unit assignment” of admission bed to “hand-off electronically completed” and was compared with pre-intervention bed posting to nursing report completion lag times. The project went live August 13, 2017 on two medical in-patient units. Four additional units were added September 20, 2017. Data collection occurred August 13, 2017-November 5, 2017.
Results/Outcomes: Overall nursing handoff time decreased 21% from an average of 40.39 minutes to 31.66 minutes across all six units. The biggest gains were seen on the neurology floor with a decrease from 44.15 minutes to 22.93 minutes. Two units saw a small increase in nursing report times (approximately one minute). Despite overall improvement, we did not meet our goal to decrease nursing report times to less than 30 minutes.
Implications: Timely nursing reports is paramount in the provision of safe patient care, especially in the setting of increasing emergency room boarding times. The Agency for Healthcare Research and Quality emphasizes the leveraging of technology to improve healthcare delivery. eHandoff is an accessible solution to the problem of throughput delays and barriers to safe patient care. The process continues to be refined with the goal of decreasing report times throughout all units in the hospital.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
|Abstract Review Only: Reviewed by Event Host
Electronic Health Record
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Showing items related by title, author, creator and subjects.
Improving door-to-ECG time for patients presenting with chest pain in the adult emergency department Baptiste, Diana Lyn; Maliszewski, Barbara; Gardner, Heather; Lindauer, Cathleen (2017-07-19)Purpose: The American Heart Association/ American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients who present with chest pain. Reducing ECG-to-door time is important ...
Outcomes of an innovative evidence-based project: Building a difficult access team in an emergency department Baptiste, Diana Lyn; Maliszewski, Barbara; Whalen, Madeleine; Gardner, Heather; Sheinfeld, Rebecca (2017-07-06)Background/Introduction: Emergency departments across the nation face challenges of longer lengths of stay due to increased volumes and patient acuity. Intravenous (IV) access is vital to emergency care, and a large ...
Medina, KatherineThe telephonic hand off process utilized to transfer ED boarders with assigned beds was causing major delays. The time from bed assignment to admission on the inpatient medical-surgical and telemetry units was 2 hours on ...
Implementation of an innovative machine learning-based triage support tool: Translating technology and research to practice Whalen, Madeleine; Gardner, Heather; Martinez, Diego; Henry, Sophia; McKenzie, Catherine; Hinson, Jeremiah; Levin, ScotSession A presented Thursday, September 27, 10:00-11:00 am Purpose: Leveraging the electronic health record (EHR), as well as translating research to clinical practice, are paramount to improving the provision of healthcare ...
Meaningful use of the EHR-Evaluating the internal and external factors affecting the timeliness of patient referrals Schacherbauer, Beverly J.With increasing numbers of patients seeking healthcare in the ambulatory setting it is necessary to evaluate processes for improving efficiency and access, while controlling costs. Timely access to specialty care is vital ...