Purpose

Improvement Tools/Methods
Limitations / Lessons Learned
Results
Process Improvement
Improving Admission Nursing Handoff
Kayla Cormier, Kimberly Cremerius, and Melissa Lowe
To facilitate accurate, efficient, and complete
handoff reporting when admitting patients from
the Emergency Department, ED, to 3North, 3N.
To improve the continuity of care provided to
patients admitted through the ED to 3N.
To improve communication and understanding
among floors about handoff process and policy.

3 North Safety Attitudes Questionnaire Plus
(2013). Results. Of the Registered Nurses on 3N:
Only 19% disagreed or strongly disagreed
that Hospital units do not coordinate well with
each other and that things fall between the
cracks when transferring patients from one
unit to another
Only 33% disagreed or strongly disagreed
that important patient care information is often
lost during shift changes.
Only 38% disagreed or strongly disagreed
that problems often occur in the exchange of
information across hospital units.
This indicates that handoff communication
was the least positive result for the floor and it
is a highlight for potential improvement
projects.
Nurses on the floor report being concerned that
inaccurate and/or incomplete handoff reports are
received from the Emergency Department.
This inconsistency in handoff reporting can lead
to a decrease in quality patient care, nurse
satisfaction, cause concern for patient safety, and
decrease the time available for the nurse to spend
at the bedside.
(Florida Hospital Tampa 3 North, 2013)

The current Electronic Medical Record, EMR,
lacks a dedicated tool to support patient handoff.
Computerized patient handoff applications can
be developed which when tested in other
hospitals increased accuracy and completeness
of handoff reporting (Wayne et. Al), decreased the
amount of time required for patient handover
(Vawdrey et. Al), and increased continuity of care
in all included studies.
Additionally, the study completed by Vawdrey
et. al demonstrated that without any special
teaching, the hospital achieved widespread
voluntary use, 50% of the users were nurses,
40% physicians, and 10% allied health. In
addition they extended the use of their program to
nearby facilities using the same EMR system.
While specific prompting from an electronic
patient handoff application is useful to
decrease errors and omissions during
patient transfers, it is only beneficial if it is
accepted and used by those transferring
patients. However if the application contains
useful information without the nurse having
to search through multiple areas of the EMR
compliance would likely be voluntary.
In addition, it would require time and
resource allocation to create and integrate
into the electronic medical record.
Florida Hospital Tampa
This problem is being evaluated using a cause
and effect fishbone diagram (see diagram 1).
In addition there will be a collegial meeting
between 3N and the ED at the beginning and
end of the project to evaluate the results




References
Collins, S. A., Stein, D. M., Vawdrey, D. K., Stetson, P. D., & Bakken, S. (2011). Content overlap in
nurse and physician handoff artifacts and the potential role of electronic health records: A
systematic review. J Biomed Inform, 44(4), 704-712. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119775/
Florida Hospital Tampa 3 North. (2013). Safety Attitudes Questionnaire Plus. Tampa, FL.
Hilligoss, B. & Zheng, K. (2012). Chart biopsy: An emerging medical practice enabled by electronic
health records and its impacts on emergency department-inpatient admission handoffs. Journal of
the American Medical Informatics Association, 20(2), 260-267. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638186/
Maughan, B. C., Lei, L., & Cydulka, R. K. (2011). ED handoffs: Observed practices and
communication errors. The American Journal of Emergency Medicine, 29(5). Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/20825820
Raptis, D. A, Fernandes, C., Chua, W., & Boulos, P. B. (2009). Electronic software significantly
improves quality of handover in a london teaching hospital. Health Informatics Journal, 15. Retrieved
from http://jhi.sagepub.com/content/15/3/191.long
Vawdrey, D. K., Stein, D. M., Fred, M. R., Bostwick, S. B., & Stetson, P. D. (2013). Implementation of
a computerized patient handoff application. AMIA Annual SymposiumProceedings Archive, 2013.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900153/
Wayne, J. D., Tyagi, R., Reinhardt, G., Rooney, D., Makoul, G., Chopra, S., & DaRosa, D. A. (2008).
Simple standardized patient handoff system that increases accuracy and completeness. Journal of
Surgical Education, 65(6), 476-485. Retrieved from
http://www.sciencedirect.com/science/article/pii/S1931720408001864
Background
Measures
This project will be evaluated using
Data from the Safety Attitudes
Questionnaire (SAQ),
ED Transfer Communication Log which
includes a three question survey regarding
transfer communication completed pre and
post intervention (results pending), and;

0
5
10
15
20
25
30
35
40
Units do not
coordinate
well with each
other
Things "fall
between the
cracks" when
transferring
patients
Important
patient care
information is
lost during
shift change
Problems
often occur in
exchange of
information
across
hospital units
Safety Attitudes Questionnaire 2013
3 North
Results based on front line caregiver responses on 3 North.
P
e
r
c
e
n
t
a
g
e

o
f

c
a
r
e
g
i v
e
r
s

w
h
o

a
g
r
e
e