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BACKGROUND/RATIONALE:
Communication breakdowns are cited as the root cause for the majority of sentinel events. Many communication errors occur during “handoffs,” when a patient’s care is transferred from one care provider to another. The information transferred during patient handoffs varies considerably in terms of breadth of content, details and accuracy. One approach to enhancing the information transfer during handoffs is to standardize both the content and information involved. The Indianapolis VAMC has developed, implemented and currently uses a computerized handoff tool that is being requested for dissemination to other VAMCs. However, relatively little is known about how best to facilitate handoffs.
OBJECTIVE(S):
Before widespread dissemination occurs, it would be prudent to formally evaluate, modify and improve the patient handoff tool (PHT) to improve its content and usability. Furthermore, identifying barriers and facilitators to implementation is critical to refinement and further dissemination of new technology and innovations. The objectives for the current proposal are to:
1. Evaluate the type and quality of information transferred using the PHT;
2. Refine the PHT to standardize and optimize knowledge transmission and usability; and
3. Describe barriers and facilitators to PHT implementation.
METHODS:
The overarching goal of the PHT evalation is to determine its capture of optimal information to provide improved patient care and to suggest modifications if needed. Three types of data collection will be used. First, a sample of 50-60 PHT forms from the Indianapolis VAMC will be coded into categories identified as critical to effective handoffs. Second, a sample of approximately 50-60 cross-coverage residents will be surveyed at the end of their shift about unanticipated patient events, information necessary to avoid unexpected events, and satisfaction with the PHT. Third, we will conduct envisioned world simulation interviews with 15-20 internal medicine residents to identify other ways to improve the PHT. Taken together, the data collected will permit modifications to the PHT, if necessary. After the data collection phase, the PHT will undergo refinement based on these assessments, along with suggested modifications from other VAMCs who have recently implemented the PHT. The modified PHT will be introduced to a sample of 10-12 internal medicine residents to assess content and usability. Additionally, as a pre-implementation step, we will contact chief residents and clinical applications coordinators at these other VAMCs to inquire about barriers and facilitators to implementing the PHT.
FINDINGS/RESULTS:
We have been able to successfully recruit participants. Evaluation and refinement of the electronic tool is ongoing.
IMPACT:
We are participating in ongoing piloting of the instrument through several other VAMCs through the VA National Center for Patient Safety. The modified PHT will be disseminated for use at other VAMCs. We will summarize lessons learned and identified best practices in implementation to aid in dissemination of this refined technological innovation to other VAMCs.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care
Keywords:
Safety
MeSH Terms:
none
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