Erin and Meghan are 2 Assistant Service Managers in the ED. This role is fast-paced and involves prompt critical thinking, decision making and active evaluation of department flow. Often, they would notice a delay in calling/giving report to the inpatient units. In June 2018, they took the initiative and created a quick audit tool to identify the barriers. This quick checklist assisted the front line ED nurses in tracking any delays they encountered related to calling report.
Erin and Meghan manually collected and evaluated the data and identified a few opportunities for improvement. Their goal was to create a formal electronic tool with consistent information that would have the potential to improve patient safety and enhance rapport with the ED and Inpatient Nurses. For example, the data showed that the average handoff time was 116 minutes from the bed ready to the patient leaving the floor. Also, 71% of handoffs required 2 or more calls and the delays were typically due to RN unavailability. Additionally, the primary ED nurse was not always available to give report and therefore the nurse giving handoff was unable to answer pertinent questions.
This preliminary data was presented to nursing leadership and the decision was made to develop a workgroup with inpatient and ED nurses. The group audited 50 charts and developed an EPIC Handoff tool that was approved by both ED and inpatient nurses. The pilot was then planned to go live with ED Observation.
Rusty worked diligently on the build for the ED nurses. As a former ED RN and nurse leader, he understood the importance of a report that could pull from data already documented in the chart. He worked with the team to ensure that the changes incorporated the needs of the frontline ED nurse.
Jean consistently made himself consistently available to the team for assistance and suggestions from a Performance Improvement perspective. He continues to assist with data evaluation and house-wide communication during Safety Week.
JB worked closely with the team to identify several areas of improvement for both ED and 9 Gold nurses. As a former 9 Gold nurse, he has a unique perspective of what the incoming report should include for the receiving nurse. He worked hard to make sure the Kardex was visible and accurate. He also carefully reviewed the interaction with ENGAGE and to ensure the alerts were working correctly.
As a current RN III on 9 Gold, Caitlyn has important insight into the workflow. She manually tracked and completed the initial audits for the pilot. She also educated her team as each change occurred. She also provided necessary feedback on the needs for the inpatient report and confidently expressed any concerns as they arose.
As the director over the ED Observation Unit, Melody Gardner heard the concerns of her staff with the initial pilot. She collaborated with Erin and Meghan from the view of her team. She organized a bi-weekly WebEx to identify areas of improvement and barriers to success. When planning for the go-live, she ensured that the workflow and report were discussed with multiple committees including VPN, Nursing policy and procedure, Nursing Practice Council, Night Shift Council, UBC Council, and Super Users. Also after the go-live Melody attended bed huddle to discuss Electronic Handoff and manually calculated the initial daily data to ensure compliance and accuracy.
Hayley played an integral role in ensuring the online education was complete and assigned the nurses who would be impacted by this project. She was approachable and easy to work with. Once the handoff went "live" the educators went floor to floor in real-time to answer any questions related to Electronic Handoff.
This project was selected because handoff is a critical piece of communication for consistent and accurate patient care. There was constant frustration from both ED and Inpatient nurses, the goal of this project to decrease confusion and increase collaboration.
The Parkland mission states, "dedicated to the health and well-being of individuals and communities entrusted to our care." This team and project embody our mission completely. Erin and Meghan identified a patient safety concern and an area of dissatisfaction for many Parkland nurses and pursued the opportunity to make a change. The team that worked on this project overcame several hurdles in order to make electronic handoff a success. If there is ever any question about what was communicated in report, there is a trackable tool for the ED or Med/Surg nurse to quickly reference. This outstanding team has displayed Parkland CIRCLES by openly and honestly communicating with one another, collaborating with each other and respecting department team members. This allowed for strong leadership of a patient safety initiative and performed with the highest levels of excellence.
The team members were selected or identified based on their roles. Each one the team members played an important role within their area of expertise and sphere of influence. They each contributed to the initial stages and ongoing success of this project and worked tightly as a team while completing individual tasks.
Electronic handoff went live on February 18th and the preliminary data is very promising! The data shows average compliance of 88% which is absolutely amazing. The project has had a significant impact on nursing practice and has provided an opportunity to streamline nursing report for patient safety. This amazing idea to have an electronic tool with all the pertinent information and to decrease confusion between the ED and Med/Surg units has been an exciting journey. A sincere thank you to Erin and Meghan for their innovative ideas and leadership.