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.
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. Objectives were to: 1) evaluate the rate at which data elements of interest were extracted from the electronic health record into the PHT, 2) assess the frequency for needing information beyond that contained in the PHT and where obtained, 3) assess physician's perceptions of the PHT, 4) identify opportunities for improvement.
We designed a multimethod study, incorporating both quantitative and qualitative approaches. We collected three types of data. First, for Objective 1, information contained in the PHT forms was coded into categories (including coding the most recent physician note). Second, for Objective 2, cross-cover residents were surveyed at the end of their shift about information omitted from the handoff. The research was conducted with internal medicine resident physicians at the Indianapolis VA Medical Center. Eligible residents were first year housestaff officers completing month-long rotations either on an internal medicine inpatient ward or in the medical intensive care unit. Third, for Objectives 3 and 4, semi-structured interviews were conducted to assess perceptions of the PHT and identify other improvement opportunitie
For objective 1, patient identifiers and medications were reliably extracted (>98%). Other types of information--allergies and code status--were more variable (<50%). For objective 2, nearly a quarter of respondents required information from physician notes not available in the PHT. For objective 3, respondents found that the PHT supported handoffs but indicated that it often excluded the assessment and plan. For objective 4, residents suggested including treatment plans.
The modified PHT has been modified based on these findings and disseminated for use at other VAMCs by a workgroup organized by the VA National Center for Patient Safety.
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