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Electronically enhancing handoffs: How one facility's switch to an electronic hall pass improved communication and safety


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After reading this article, you will be able to:

  • Describe the electronic patient handoff process at Abington (PA) Memorial Hospital (AMH)

Staff members at AMH knew their patient handoff process needed work. Like that of many other hospitals, AMH’s process included the use of a paper format to communicate important patient information from one provider of care to the next.

However, the form would often be filled out improperly, labels would be missing, and ultimately, the receiver might not be aware of everything he or she needed to know about a patient, putting the patient at risk for an error in care. The hospital also needed to stay in compliance with National Patient Safety Goal 02.05.01, concerning handoff communication. Additionally, nurses often had to double-document information on the handoffs that was already captured in the electronic medical record (EMR).

AMH had adopted computer physician order entry and clinical documentation by September 2007 and decided to use the EMR to enhance its handoff process. At the time, the hospital also used a system that took information from the EMR to provide patients with a daily care report.

“We thought maybe we could use that type of technology—that report writing—to get better, more accurate information in a simple way to ancillary staff,” says Diane Humbrecht, MSN, RN, C, nurse director of informatics at AMH.

Humbrecht and her colleague Linda Mimm, RN, BC, DL, CPHQ, safety and quality specialist at AMH’s Center for Patient Safety & Quality, worked with a team to decide how the process would function and what information should appear on the new “electronic hall pass.”

The team decided that the information contained on the handoff should be pulled directly from the EMR, using the documentation notes that the nurse wrote each morning. However, only data deemed pertinent would be included, as the team wanted to limit the printout to one page. This included items such as whether the patient was a fall risk, whether the patient was on oxygen, and the patient’s isolation and code statuses.

Nurses were trained to use the EMR so that if a patient was to be transported to another department, they could merely go into that patient’s record and click “print hall pass” for all of the necessary information to be printed. (See p. 4 for an explanatory flow chart.)

Transfer staff members were trained to make sure that any patient ready to be escorted had a printed hall pass and to reconcile that information. If information was missing, the transfer staff member would stop the process until he or she could locate the information.

The departments receiving patients from a transfer played a large role in redefining this process. Mimm says she originally was collecting data regarding whether the information on the hall pass was present, but she has since shifted to understanding who is receiving and using that information.

“What’s nice is we can give monthly feedback to the receiving departments on how they are doing with reviewing the hall pass, and we’re able to hit compliance because they were getting timely feedback,” says Mimm.

This process has worked well since implementation and has increased the awareness of the support staff, without whom this process redesign would not have been possible, says Mimm.

“The whole process made me really appreciate the people outside of the nursing department who really need to know more about our patients and are concerned about their safety,” she says.

Source

Adapted from Briefings on Patient Safety, April 2009, HCPro, Inc.