Don’t Fumble the Handoff!
Tackling Effective Communication
Courtney Gould, RN, BSN (MICU)
Lisa Nolan, RN, AD (SICU)
Kate Shaw, RN, BSN (Emergency)
Nicole Howley, RN, BSN (Emergency)
South Shore Hospital
Purpose and Goals
 To improve communication, build better relationships,
and build teamwork between the Emergency Department
(ED) and the Intensive Care Units (ICUs)
 To have uniform use of Situation, Background,
Assessment, and Recommendation (SBAR) format
 To decrease systems barriers, so more handoffs are completed
with courtesy and mutual respect
 To see improved responses on nursing satisfaction survey
Purpose and Goals
 To improve patient safety as evidenced by a decrease in
incident reports directly related to handoff
miscommunication
 To reduce readmissions and length of stay, as well as
potential legal costs
 AORN Institute of Medicine reports that costs associated
with medical errors is $8 billion to $29 billion annually
($8,750 per patient) and that communication
issues are the leading factor in most cases
Specific Activities and Key Dates
November 15, 2012
 The first meeting; we decided that first day we were very
creative, and we were going to be a winning team!
Specific Activities and Key Dates
January 2013
 Dominance, Influence, Steadiness, and Conscientiousness
(DiSC) assessment; we realized we have different strengths
and skills
Action Plan
 February 2013: Spent a day in each
others' shoes
 May 2013: Attended NTI in Boston as
a team
 June 2013: Developed a fun slogan
and PowerPoint; began to plan our
mixer
 August 2013: Video developed to
create awareness
Action Plan
 September 2013: Weekly e-mails sent to promote mixer
and build momentum
 October 2013: Social mixer held for team building
 November 2013: Reinforced the use of the SBAR and
importance of mutual respect
 Ongoing: Cross-training for new employees
What is the problem or breakdown in
the process?
 Errors occur during handoff that directly impact patient
safety
 Lack of understanding of workload, workflow, and
priorities between the ED and ICU
 No formal structure of report and handoff from ED to ICU
 Strained relationship between the 2 areas
Why Standardize Communication?
 Focus on the patient not the people
 Standardized format allows staff to have common
expectations
 What is going to be communicated?
 How will the communication be structured?
 What are the required elements?
Why Standardize Communication?
 S: Situation
 Patient age, gender, mental status, stable/unstable
 B: Background
 Pertinent medical history, allergies, sensory impairment, family
location, religion/culture, interpreter if needed, valuables
 A: Assessment
 Vital signs, isolation/precautions, risk factors, issues of concern
 R: Recommendation
 Specific care required immediately/soon, priority areas (pain
control, IV, family concerns)
What Do We Know About the Problem?
 South Shore Hospital ED has the second-highest volume of
patients in the state of Massachusetts
 Nurses trying to give and receive report have frequent
interruptions
 Heavy volume of patients and workload makes nurses feel
rushed and unable to dedicate time for handoff – they
cannot address all important issues
May 2013: SurveyMonkey Sent to Staff
ICU Survey
Please complete this quick checklist after report and patient transfer from
the ED:
1. Did you have to call the ED nurse back to receive report?
2. Was report given in SBAR format?
3. Were there any questions you asked able to be answered by the ED RN?
4. Did you review the “special panels” page or any other patient
information online before or during report?
5. Did the nurse you received report from transfer the patient to the unit
themselves?
6. Did the patient arrive to the ICU as you expected from the report you
were given?
7. Did you greet the patient in the room upon transfer from the ED?
Question 7
Question 6
Question 5
Question 4
Question 3
Question 2
Question 1
ICU Survey Results
100%
75%
50%
Yes
25%
0%
No
ED Survey
Please complete this quick checklist after report and patient transfer to
the ICU:
1. When you called the ICU to give report, were you connected to the
nurse the first time?
2. Did you follow the SBAR format when giving report?
3. Were you interrupted at any point giving report by the receiving RN?
4. Were you able to answer all questions asked by the receiving RN?
5. Did you as the primary RN accompany/transfer the patient to the unit?
6. Were you met in the room by the primary RN receiving the patient?
Question 6
Question 5
Question 4
Question 3
Question 2
Question 1
ED Survey Results
100%
75%
50%
Yes
25%
0%
No
Key Challenges to the Project
 This was a challenging topic for data collection; not easy to
quantify a culture change
 Juggling 4 schedules, and trying to make time
 Getting staff to buy in and agree with our plan; there was
much resistance early on
 Our ICU manager left the organization
 High volume of patients and exceptionally
high acuity in the ED and the ICUs
 Culture changes can be slow and difficult
Unintended Positive Outcomes to Date
 We have become great friends. It is very difficult to be rude or
inconsiderate to a great friend. This is our hope of secondary gain for all
of our coworkers through our work, the mixer, and our reinforcement.
 The initial Survey Monkey was responded to by 30% of staff which was
encouraging to us!
 We have learned through research and group discussion with the other
CSI groups how very critical communication is. Miscommunication is
responsible for 60% to 70% of all sentinel events!
 There is increased awareness to communicate with the RNs on the
opposite floor when giving report.
How Do We Plan to Maintain and
Sustain the Project?
 Continue to build relationships between ICU and ED by
encouraging the hospital to allow for a few hours of orientation
devoted to visiting and working on the other unit.
 Continue to encourage staff to use the SBAR format during
handoff.
 Continue to encourage staff to transport patients between units
themselves to allow for relationships to form between nurses
and to ensure patient safety.
 Encourage our current leadership to include the handoff video
as part of our current mandatory skills days each year.
Fiscal Impact
 AORN reports costs associated with medical errors is
$8,750 per patient
 We had 10 incident reports that were related to handoff in
the month of November 2012 and zero incident reports
related to handoff in the month of February 2014
 $8,750 x 10 incident reports = $87,500 per month
 $87,500 x 12 months = projected annual savings of
$1,050,000
Fiscal Impact
 AORN reports costs associated with medical errors is $8
billion to $20 billion annually ($8,750 per patient) and that
communication issues are the leading factor in most cases.
 Patient safety initiatives … PRICELESS
Special Thanks
To AACN and the CSI Academy:
 Susan Lacey, RN, PhD, FAAN, Program Director, AACN CSI
Academy
 Dave Hanson, RN, MSN, ACNS-BC, NEA-BC, AACN CSI
Academy Boston Lead Faculty
 Adrienne Olney, AACN CSI Academy Program Manager
To South Shore Hospital:
 Timothy Quigley, RN, MBA, Chief Nursing Officer
 Donna Chase, RN, MHA/MS, Director Accreditation/Clinical
Professional Development & CSI Coach
Lastly we would like to thank the staff on our units
for their dedication to our patients and families and
all of the support shown to us with this project!
References
1. Caple, C. Hand Off : Patient Safety. Evidence Based Care Sheet. 2012.
2. Iacono, MV. Handoff Communication: Opportunities for Improvement.
Journal of PeriAnesthesia Nursing. 2009;24(5):324-326.
3. Murray, A. How to Change Your Organization’s Culture. The Wall Street
Journal. 2009.
4. Woods, MS. Effective Handoff Communication, Part 1. Developing and
Improving New SBAR Tool. The Joint Commission Perspectives on
Patient Safety. 2010; 10(10):3-5,11.
5. Conaboy, C. Children's Hospital creates system for safe patient
handoffs: Researchers map stately to reduce errors. The Boston Globe.
2013.
6. AORN. Standardizing Hand Offs for Patient Safety. AORN.org. 2013.
Play Communication/Handoff Video of
South Shore Hospital CSI Team
Questions?