Using electronic nursing handoff to improve timeliness of clinical information exchange and reduce boarding time for admitted patients in the emergency department

Abstract

<p>Session C presented Thursday, September 27, 1:00-2:00 pm</p> <p><strong>Purpose:</strong> 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.</p> <p><strong>Design: </strong>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.</p> <p><strong>Participants/Subjects: </strong>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 &ldquo;fast facts&rdquo; 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 &ldquo;unit assignment&rdquo; of admission bed to &ldquo;hand-off electronically completed&rdquo; 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.</p> <p><strong>Results/Outcomes:</strong> 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.</p> <p><strong>Implications: </strong>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.</p>