Improving Hand-Off Process between the Emergency Department (ED) and
Inpatient Units (4B&5B)
5B Nursing Unit: Sara Bhullar, RN, Karla Jackson, RN, Julie Grunawalt, RN, MS, GCNS-BC, & Winnie Wood, MSN, RN, CNS
4B Nursing Unit: Jessie Rees , RN, Kim Ploegstra, RN
Emergency Department: John Fairchild, MSN, RN, Margaret Fast, MSN, RN, CNS & Candice Catanzarite, RN
Emergency Department, 4B, 5B Nursing Staff
University of Michigan Health System, Ann Arbor, MI
Purpose
Implementation
Strategies
Significance
In November 2010 4B and 5B partnered with the ED to develop an
improved
hand-off
process.
In
our
process,
the
ED
RN
faxed
report
to
The goal of this project is to improve patient safety and
nurse satisfaction by standardizing the hand-off process unit and paged the unit Charge with the primary ED nurse call back
number.
Unit
Charge
or
RN
called
ED
if
further
patient
information
through verbal communication of critical information
was require. A SBAR tool was utilized to guide verbal report. All
utilizing a Situation-Background-Assessmentnurses
were
educated
on
the
hand-off
process.
Recommendation (SBAR) tool.
To evaluate the outcomes, inpatient nurses completed admit
evaluations (barriers for not obtaining verbal report and if they called
for report). Inpatient nurses were also surveyed regarding if it
Synthesis
improved patient safety, communication, and quality of patient care.
Current literature from the Joint Commission reports that
breakdown in communication is the root cause of 65% of
all sentinel events (Mascioli, 2009). The SBAR tool has
been found to be a communication technique resulting in
consistent, organized communication (Woodhall, et al,
2008). According to Welsh (2009), printed report does not
include content transfer, clarification and inquiry, and
historical review
Change
The inpatient charge nurse received a page and fax
from the ED nurse containing admission information.
Time constraints could prevent the ability for the
inpatient nurse to review the printed report therefore
critical information may have been missed.
• In order to improve patient safety, communication among caregivers
should be timely, unambiguous, accurate, and understood by the
recipient.
• We have had the opportunity to share the project with the Hospital
Patient Safety Committee and will be presenting the project at
Nursing Leadership Forum
• The Pilot will be expanding to other adult inpatient units (5A and 5C).
• Currently areas within the institution that are similar to the ED are
interested in piloting this handoff process with the inpatient units.
Evaluation
Nurse Survey results (N=61):
68% felt the process improved patient safety
58% felt there was improved communication
64% felt quality of patient care had improved
77% of the completed evaluations indicated that the in-patient nurse
contacted the ED RN and received verbal SBAR report.
Barriers identified were lack of ED nurse’s phone number, some Nurses
were not receptive to the process change, and inpatient nurses
inconsistently using the SBAR format.
Improved Quality of Patient Care
Improved Communication between
ED & Inpatient units
Improved Patient Safety
References
Haig, M. Kathleen ( 2006) SBAR: A Shared Mental Model for Improving Communication
Between Clinicians. Joint Commission Journal on Quality and Patient Safety, 32(3):167-175.
Mascioli, S., Laskowsi-Jones, L., & Urban, S. (2009). Improving handoff communication.
Nursing, 39 (2), 52-55.
Riesenberg, L. A., Leitch, B., & Cunningham, J. M. (2010). Nursing handoffs: A systematic
review of the literature. American Journal of Nursing, 110(4), 24-34.
Welsh, C., Flanagan, M., & Ebright, P. (2009). Barriers and facilitators to nursing handoffs:
Recommendations for redesign. Nursing Outlook , 58 (3), 148-154.
Woodhall, L. J., Vertacnik, L., & McLaughlin, M. (2008). Implementation of the SBAR
communication technique in a tertiary center. Journal of Emergency Nursing, 34(4), 314317.