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BMJ Quality Improvement Report
EMR-based handoff tool improves completeness of internal medicine residents’ handoffs
  1. Rebecca L Tisdale1,
  2. Zac Eggers2,
  3. Lisa Shieh3
  1. 1 Department of Medicine, Stanford Hospital and Clinics, Stanford, California, USA
  2. 2 Inpatient Unit Nursing Management, Stanford Hospital and Clinics, Stanford, California, USA
  3. 3 Department of Medicine, Stanford School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Rebecca L Tisdale; rtisdale{at}stanford.edu

Abstract

Background The majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.

Aim To measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.

Intervention This EMR-based handoff tool included a radio button prompting users to classify patients as stable, a ‘watcher’ or unstable. It automatically pulled in EMR data on the patient’s 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled ‘Active Issues’, ‘Action List (To-Dos)’ and ‘If/Then’ to fill in.

Implementation and evaluation Written handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.

Results Handoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.

Conclusion A simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.

  • handoff
  • information technology
  • graduate medical education
  • quality improvement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:©http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2017-000188

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    Footnotes

    • Contributors RLT and LS performed all processes related to handoff data and drafted the manuscript and take responsibility for the overall content. ZE designed and collected nursing survey data. RLT submitted the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.