Utilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology

Abstract

Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,^1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented.

Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure.

Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift.

Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services.

Keywords

handoff - handover - electronic medical record

Publication History

Received: 03 August 2020

Accepted: 31 August 2020

Article published online:
30 October 2020

• References

• 1 Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care 2005; 14 (06) 401-407
• 2 Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med 2008; 168 (16) 1755-1760
• 3 Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 2005; 80 (12) 1094-1099
• 4 Wray CM, Chaudhry S, Pincavage A. et al. Resident shift handoff strategies in US internal medicine residency programs. JAMA 2016; 316 (21) 2273-2275
• 5 Arora VM, Manjarrez E, Dressler DD, Basaviah P, Halasyamani L, Kripalani S. Hospitalist handoffs: a systematic review and task force recommendations. J Hosp Med 2009; 4 (07) 433-440
• 6 Starmer AJ, O'Toole JK, Rosenbluth G. I-PASS Study Education Executive Committee. et al. Development, implementation, and dissemination of the I-PASS handoff curriculum: a multisite educational intervention to improve patient handoffs. Acad Med 2014; 89 (06) 876-884
• 7 Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I-PASS Study Group. I-pass, a mnemonic to standardize verbal handoffs. Pediatrics 2012; 129 (02) 201-204
• 8 Arora VM, Berhie S, Horwitz LI, Saathoff M, Staisiunas P, Farnan JM. Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise. J Hosp Med 2014; 9 (07) 441-446
• 9 Doers ME, Beniwal-Patel P, Kuester J, Fletcher KE. Feedback to achieve improved sign-out technique. Am J Med Qual 2015; 30 (04) 353-358
• 10 Feraco AM, Starmer AJ, Sectish TC, Spector ND, West DC, Landrigan CP. Reliability of verbal handoff assessment and handoff quality before and after implementation of a resident handoff bundle. Acad Pediatr 2016; 16 (06) 524-531
• 11 Lee SH, Fisher DA, Mah H, Goh WP, Phan PH. A qualitative study of sign-out processes between primary and on-call residents: relationships in information exchange, responsibility and accountability. Int J Qual Health Care 2017; 29 (05) 646-653
• 12 Starmer AJ, Spector ND, Srivastava R. I-PASS Study Group. et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014; 371 (19) 1803-1812
• 13 Allen S, Caton C, Cluver J, Mainous III AG, Clyburn B. Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education. Acad Med 2014; 89 (10) 1366-1369
• 14 Coffey M, Thomson K, Li SA. et al. Resident experiences with implementation of the I-PASS handoff bundle. J Grad Med Educ 2017; 9 (03) 313-320
• 15 Sawatsky AP, Mikhael JR, Punatar AD, Nassar AA, Agrwal N. The effects of deliberate practice and feedback to teach standardized handoff communication on the knowledge, attitudes, and practices of first-year residents. Teach Learn Med 2013; 25 (04) 279-284
• 16 Arora VM, Greenstein EA, Woodruff JN, Staisiunas PG, Farnan JM. Implementing peer evaluation of handoffs: associations with experience and workload. J Hosp Med 2013; 8 (03) 132-136
• 17 McCrory MC, Aboumatar H, Custer JW, Yang CP, Hunt EA. “ABC-SBAR” training improves simulated critical patient hand-off by pediatric interns. Pediatr Emerg Care 2012; 28 (06) 538-543
• 18 Aboumatar H, Allison RD, Feldman L, Woods K, Thomas P, Wiener C. Focus on transitions of care: description and evaluation of an educational intervention for internal medicine residents. Am J Med Qual 2014; 29 (06) 522-529
• 19 Johnson DP, Zimmerman K, Staples B, McGann KA, Frush K, Turner DA. Multicenter development, implementation, and patient safety impacts of a simulation-based module to teach handovers to pediatric residents. Hosp Pediatr 2015; 5 (03) 154-159
• 20 Farnan JM, Paro JA, Rodriguez RM. et al. Hand-off education and evaluation: piloting the observed simulated hand-off experience (OSHE). J Gen Intern Med 2010; 25 (02) 129-134
• 21 Gakhar B, Spencer AL. Using direct observation, formal evaluation, and an interactive curriculum to improve the sign-out practices of internal medicine interns. Acad Med 2010; 85 (07) 1182-1188
• 22 Rüdiger-Stürchler M, Keller DI, Bingisser R. Emergency physician intershift handover - can a dINAMO checklist speed it up and improve quality?. Swiss Med Wkly 2010; 140: w13085