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Ryan SL, Logan M, Liu X, Shahian DM, Mort E. Long-Term Sustainability and Adaptation of I-PASS Handovers. Jt Comm J Qual Patient Saf 2023; 49:689-697. [PMID: 37648628 DOI: 10.1016/j.jcjq.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Inadequate communication during transitions of care is a major health care quality and safety vulnerability. In 2013 Massachusetts General Hospital (MGH) embarked on a comprehensive training program using a standardized handover system (I-PASS) that had been shown to reduce adverse events by 30% even when not completely executed on each patient. In this cross-sectional study, the authors sought to characterize handover practices six years later. METHODS Using a standardized interview tool, the researchers evaluated handovers between responding clinicians in 10 departments and then validated these findings through direct observations, allowing for flexibility and customization in the I-PASS elements. The study qualitatively compared I-PASS element use in verbal handovers to MGH early postintervention data, as well as verbal and written handovers with the I-PASS Study Group's postintervention results. RESULTS The authors observed 156 verbal and reviewed 182 written patient handovers. Ninety percent of departments adhered at least partially to the I-PASS system. Average handover duration ranged from 0.6 to 2.1 minutes per established patient. The service with best I-PASS adherence also consistently included the most information per unit of time. Acknowledging substantial differences in study technique, MGH adherence was, on average, comparable or better on all I-PASS elements in verbal handovers and on three of four elements of written handovers compared with the I-PASS Study Group's postintervention results. CONCLUSION Although uptake has varied across services, six years after hospitalwide implementation of I-PASS, the majority of services are performing structured and sequenced handovers, most of which include some elements of the I-PASS system. Those services with the best I-PASS adherence conducted the most efficient handovers.
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Soegaard Ballester JM, Bass GD, Urbani R, Fala G, Patel R, Leri D, Steinkamp JM, Denson JL, Rosin R, Adusumalli S, Hanson CW, Koppel R, Airan-Javia S. A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care. Appl Clin Inform 2021; 12:1120-1134. [PMID: 34937103 PMCID: PMC8695057 DOI: 10.1055/s-0041-1740256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Clinical workflows require the ability to synthesize and act on existing and emerging patient information. While offering multiple benefits, in many circumstances electronic health records (EHRs) do not adequately support these needs. OBJECTIVES We sought to design, build, and implement an EHR-connected rounding and handoff tool with real-time data that supports care plan organization and team-based care. This article first describes our process, from ideation and development through implementation; and second, the research findings of objective use, efficacy, and efficiency, along with qualitative assessments of user experience. METHODS Guided by user-centered design and Agile development methodologies, our interdisciplinary team designed and built Carelign as a responsive web application, accessible from any mobile or desktop device, that gathers and integrates data from a health care institution's information systems. Implementation and iterative improvements spanned January to July 2016. We assessed acceptance via usage metrics, user observations, time-motion studies, and user surveys. RESULTS By July 2016, Carelign was implemented on 152 of 169 total inpatient services across three hospitals staffing 1,616 hospital beds. Acceptance was near-immediate: in July 2016, 3,275 average unique weekly users generated 26,981 average weekly access sessions; these metrics remained steady over the following 4 years. In 2016 and 2018 surveys, users positively rated Carelign's workflow integration, support of clinical activities, and overall impact on work life. CONCLUSION User-focused design, multidisciplinary development teams, and rapid iteration enabled creation, adoption, and sustained use of a patient-centered digital workflow tool that supports diverse users' and teams' evolving care plan organization needs.
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Affiliation(s)
- Jacqueline M Soegaard Ballester
- Division of General Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Geoffrey D Bass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Richard Urbani
- Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Glenn Fala
- Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Rutvij Patel
- Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Damien Leri
- Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Jackson M Steinkamp
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua L Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States
| | - Roy Rosin
- Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Clarence William Hanson
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Ross Koppel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Institute of Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Sociology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Biomedical informatics, University of Buffalo (SUNY), Buffalo, New York, United States
| | - Subha Airan-Javia
- Section of Hospital Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Founder/CEO, CareAlign, Philadelphia, Pennsylvania, United States
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Chen L, Guo US, Bhesania S, Shah H, Ali E, Mehta P. For Residents, by Residents: Developing a Physician Handoff Tool at a University Affiliated Community Hospital. Cureus 2021; 13:e18352. [PMID: 34725604 PMCID: PMC8555754 DOI: 10.7759/cureus.18352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 11/15/2022] Open
Abstract
The 80-hour per week work limit resulted in an increased number of patient handoffs. A satisfactory handoff system should optimize the exchange of vital patient information while concisely minimizing error. This project describes our experience and lessons learned in successfully developing and implementing an Electronic Health Record (EHR)-integrated handoff system based on the I-PASS model. The handoff system, termed Physician Handoff, was refined through end-user feedback. End-users were evaluated on the quality of handoff in the following categories: Illness Severity, Patient Summary, Action List, and Situational Awareness. Resulting survey showed high adoption and satisfaction rate with Physician Handoff. Success can be attributed to interdepartmental collaboration, credentialing the users, and recognizing the importance of end-user feedback.
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Affiliation(s)
- Lu Chen
- Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Uta S Guo
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Siddharth Bhesania
- Internal Medicine, Overlook Medical Center, Summit, USA.,Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Hardikkumar Shah
- Gastroenterology and Hepatology, Saint Joseph's University Medical Center, Paterson, USA
| | - Emdad Ali
- Internal Medicine, OhioHealth Physician Group, Columbus, USA
| | - Parag Mehta
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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Callahan A, Shah NH, Chen JH. Research and Reporting Considerations for Observational Studies Using Electronic Health Record Data. Ann Intern Med 2020; 172:S79-S84. [PMID: 32479175 PMCID: PMC7413106 DOI: 10.7326/m19-0873] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Electronic health records (EHRs) are an increasingly important source of real-world health care data for observational research. Analyses of data collected for purposes other than research require careful consideration of data quality as well as the general research and reporting principles relevant to observational studies. The core principles for observational research in general also apply to observational research using EHR data, and these are well addressed in prior literature and guidelines. This article provides additional recommendations for EHR-based research. Considerations unique to EHR-based studies include assessment of the accuracy of computer-executable cohort definitions that can incorporate unstructured data from clinical notes and management of data challenges, such as irregular sampling, missingness, and variation across time and place. Principled application of existing research and reporting guidelines alongside these additional considerations will improve the quality of EHR-based observational studies.
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Affiliation(s)
- Alison Callahan
- Center for Biomedical Informatics Research, School of Medicine, Stanford University (A.C., N.H.S.)
| | - Nigam H Shah
- Center for Biomedical Informatics Research, School of Medicine, Stanford University (A.C., N.H.S.)
| | - Jonathan H Chen
- Division of Hospital Medicine, School of Medicine, Stanford University (J.H.C.)
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Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
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Abraham J, Ihianle I, Ward CE, Arora VM, Kannampallil TG. Comparative assessment of content overlap between written documentation and verbal communication: an observational study of resident sign-outs. JAMIA Open 2018; 1:210-217. [PMID: 31984333 PMCID: PMC6951999 DOI: 10.1093/jamiaopen/ooy027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/15/2018] [Accepted: 07/02/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Effective sign-outs involve verbal communication supported by written or electronic documentation. We investigated the clinical content overlap between sign-out documentation and face-to-face verbal sign-out communication. Methods We audio-recorded resident verbal sign-out communication and collected electronically completed ("written") sign-out documentation on 44 sign-outs in a General Medicine service. A content analysis framework with nine sign-out elements was used to qualitatively code both written and verbal sign-out content. A content overlap framework based on the comparative analysis between written and verbal sign-out content characterized how much written content was verbally communicated. Using this framework, we computed the full, partial, and no overlap between written and verbal content. Results We found high a high degree of full overlap on patient identifying information [name (present in 100% of sign-outs), age (96%), and gender (87%)], past medical history [hematology (100%), renal (100%), cardiology (79%), and GI (67%)], and tasks to-do (97%); lesser degree of overlap for active problems (46%), anticipatory guidance (46%), medications/treatments (15%), pending labs/studies/procedures (7%); and no overlap for code status (<1%), allergies (0%) and medical record number (0%). Discussion and Conclusion Three core functions of sign-outs are transfer of information, responsibility, and accountability. The overlap-highlighting what written content was communicated-characterizes how these functions manifest during sign-outs. Transfer of information varied with patient identifying information being explicitly communicated and remaining content being inconsistently communicated. Transfer of responsibility was explicit, with all pending and future tasks being communicated. Transfer of accountability was limited, with limited discussion of written contingency plans.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology and Institute for Informatics, School of Medicine, Washington University in St. Louis, St Louis, Missouri, USA
| | - Imade Ihianle
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Charlotte E Ward
- Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Thomas G Kannampallil
- Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Eckert MD, Agapoff Iv J, Goebert DA, Hishinuma ES. Training Psychiatry Residents in Patient Handoffs Within the Context of the Clinical Learning Environment Review. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:262-264. [PMID: 28975532 DOI: 10.1007/s40596-017-0821-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
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Motulsky A, Wong J, Cordeau JP, Pomalaza J, Barkun J, Tamblyn R. Using mobile devices for inpatient rounding and handoffs: an innovative application developed and rapidly adopted by clinicians in a pediatric hospital. J Am Med Inform Assoc 2018; 24:e69-e78. [PMID: 27554824 DOI: 10.1093/jamia/ocw107] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/15/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To describe the usage of a novel application (The FLOW) that allows mobile devices to be used for rounding and handoffs. Materials and Methods The FLOW provides a view of patient data and the capacity to enter short notes via personal mobile devices. It was deployed using a "bring-your-own-device" model in 4 pilot units. Social network analysis (SNA) was applied to audit trails in order to visualize usage patterns. A questionnaire was used to describe user experience. Results Overall, 253 health professionals used The FLOW with their personal mobile devices from October 2013 to March 2015. In pediatric and neonatal intensive care units (ICUs), a median of 26-26.5 notes were entered per user per day. Visual network representation of app entries showed that usage patterns were different between the ICUs. In 127 questionnaires (50%), respondents reported using The FLOW most often to enter notes and for handoffs. The FLOW was perceived as having improved patient care by 57% of respondents, compared to usual care. Most respondents (86%) wished to continue using The FLOW. Discussion This study shows how a handoff and rounding tool was quickly adopted in pediatric and neonatal ICUs in a hospital setting where patient charts were still paper-based. Originally developed as a tool to support informal documentation using smartphones, it was adapted to local practices and expanded to print sign-out documents and import notes within the medicolegal record with desktop computers. Interestingly, even if not supported by the nursing administrative authorities, the level of use for data entry among nurses and doctors was similar in all units, indicating close collaboration in documentation practices in these ICUs.
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Affiliation(s)
- Aude Motulsky
- Clinical and Health Informatics Research Group, Faculty of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Jenna Wong
- Clinical and Health Informatics Research Group, Faculty of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | | | | | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, Faculty of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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S. Blondon K, Ehrler F, Le Godais S, Wojtasikiewicz JY, Couderc C. Approaches to Improving Nursing Handoffs in Surgical Wards. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.79075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Vidyarthi AR, Coffey M. Paperless handover: are we ready? BMJ Qual Saf 2015; 25:299-301. [DOI: 10.1136/bmjqs-2015-005027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/03/2022]
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