Olwen Kelleher-Gurry, MSN-RN

Improving Emergency Department Handoff

The purpose of this project is to improve patient handoff for registered nurses and patient care technicians in Nuvance Health’s Danbury and New Milford Hospital Emergency Departments (ED). The goal is to improve patient safety, improve communication during bedside shift reports, and improve patient satisfaction scores. These goals were identified as priority to decrease the potential for “near misses” and allows for an interactive exchange between the caregivers and patients/families.The transfer of care of emergency department patients is a high-risk event and more handoffs occur in the ED than anywhere else in the hospital. Up to 80% of serious errors and sentinel events in hospitals are caused by miscommunications, of which handoff errors are a leading source. A direct observation audit tool was developed to measure location (bedside, hallway or nurse’s station) of the verbal handoff and which handoff method staff utilize when giving report. Experience has shown that handoff at the nurse’s station or in the hallway are less effective and increases risk of harm to patient. This evaluation method examined duration and location of handoff and stakeholders involved to test the theory that bedside shift report is proven a safe practice for our patients. Bedside handoff involves the oncoming nurse and off going nurse involving the patient in their plan of care. An online survey was emailed to all staff for participation. Direct one-to-one feedback was provided to discuss and compare the impact of handoff at the bedside. Qualitative data revealed time restraints and distractions as deficiencies in infrastructure to support handoffs.The results of direct observation of Bedside Shift Report (BSR) audit review survey data revealed more than 58% of staff perform BSR and 42% do not perform bedside shift report at the bedside. Results from the online survey indicated improvement in staff performing BSR, 76% of staff stated they perform BSR and 24% stated they do not perform BSR.The Joint Commission recognizes and supports the literature in utilizing standardized patient handoffs and transfer methods that reduce risks to patients. The handoff methods used at Danbury and New Milford EDs to perform handoff at the bedside include SBAR, TeamSTEPPS, and I-PASS which are standardized patient handoffs. More education is needed for staff on BSR to emphasize the vital necessity of handoffs for patient safety and integration into nursing practice. There is a lack of robustly designed studies examining the impact of nursing handoff interventions. Additional research is needed to provide empirical evidence on the handoff process, and for more meticulous studies of nursing handoff interventions. Future education involves having all staff attend effective communication training such as TeamSTEPPS to enhance communication and team behaviors. Additional steps could include review of BSR at our sister hospitals and identification of which standardized patient handoff method works best to achieve our goals and provide the best care to our patients.