Computerized Patient Hand-Off Tool Shows Promise in Increasing Patient Safety

According to the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), most medical errors are due to failures in communication. Improving and standardizing information transfer between physicians may reduce susceptibility to this type of failure. To help achieve this goal, clinicians at the Indianapolis VAMC use a computerized patient hand-off tool (PHT) that extracts information from the electronic health record to populate a form that is printed and given to the cross-over physician. This study sought to: 1) evaluate the rate at which data were extracted from VA's electronic medical record into the PHT; 2) assess the frequency for needing information beyond that contained in the PHT; and 3) assess physicians' perceptions of the PHT, as well as opportunities for improvement. Investigators analyzed information from 1264 PHT forms, in addition to end-of-shift surveys from 35 cross-over residents (internal medicine), and interviews with 18 of the participating residents.

Overall, findings show that the PHT reliably extracts information from the electronic health record. However, while patient identifiers and medications were reliably extracted (>98%), other types of information were more variable (e.g., allergies and code status, <50%). When the patient's assessment, code status, relevant lab data, and short-term concerns were included in the PHT form, residents were less likely to report missing information in the physician hand-off. Residents preferred PHT content that included: patient medication list, assessment and plan from the most recent physician note, and list of anticipated problems and recommendations for treatment. The primary suggestion for improving the PHT form was that it be organized by patient location (e.g., ward patients grouped together). Authors suggest that the PHT, which is marked for dissemination to other VAMCs, has considerable potential for improving patient safety.

Flanagan M, Patterson E, Frankel R and Doebbeling B. Evaluation of a physician informatics tool to improve patient handoffs. Journal of the American Medical Informatics Association July-August 2009;16(4):509-15.

This study was funded by HSR&D. Drs. Flanagan, Frankel and Doebbeling are part of HSR&D's Center for Implementing Evidence-Based Practice in Indianapolis, IN.