Electronic Hand-off (e-Handoff) Report by Naomi D. James, RN BSN CPAN

E-handoff: An innovative tool for clear, effective, verbal report.

The majority of my Nursing career has been spent in the intensive care and surgical setting. Working in these settings has shown me how important clear and direct communication is. There are so many crucial pieces of the puzzle of patient care that get lost during shift report and handoff report. Everyone has different interpretations of what information is relevant and necessary to be included in the conversation. And certain information ommissions can be lethal and drastically affect patient care. For example a STAT lab result. Personally, I find it aggravating and unrealistic for nurses to read an entire chart before addressing their patient. However, I have encountered many instances where the nurse giving me report will say "It's in the chart." Yes, the patients' information is in the chart. Where it is and how to find it in a timely manner is the daily challenge that I see myself and many nurses facing.  I prefer to talk face to face and I heavily dislike writing down information while someone is talking to me. Bedside report should be a free communication venue for everyone involved.  Verbal report can be daunting and lengthy when there is a vast amount of details to cover. Effective communication is key in the nursing profession and a system that generated all of the foundational patient information in one document would be sublime.

An effective verbal report is an essential component of patient safety in the peri-operative setting. The surgical patient transfers through multiple different places in the surgical department, for example, the preoperative holding area, the operative room, and the post-anesthesia care unit. According to Robinson (2016), effective hand-off communication eases the flow of patient transition, facilitates immediate patient evaluation, and expedites clinical interventions. Effective handoff communication also decreases adverse events and promotes a safer perioperative environment. It is evidenced by Robinson (2016) that inaccurate hand-off report is the source of many errors in the perioperative department. The goal of hand-off report is to improve patient safety and enhance communication. It is unfortunately common that handoff report is informal, unstructured, and inconsistent. Many nurses don’t receive a formal verbal or written statement on patients that they receive. Handoff that is missing relevant and applicable information about the patients’ history and current medical status can result in severe medical errors (Allen & American Society of PeriAnesthesia Nurses, 2014). To maximize patient safety efforts Ratcliff et al., (2017) notes that hand-off report between nurses in the perioperative setting should include pertinent information such as vital signs, incision sites, and surgical plan of care. Whether the story of information takes place in person or over the telephone, an electronic hand-off system could improve the process of nursing communication. Adopting the E-handoff tool will help improve the flow of patient care among nursing staff. This tool can create an opportunity for nurses to have bedside report in person and leave the documentation in the chart. It is evidenced by Ratcliff et al., (2017), that nurses rate a higher satisfaction with a verbal description in person and that patients feel a sense of security while hearing their caregivers talk about their care. The e-Handoff report is a more accessible process and includes the patient in the plan of care. 

In efforts to increase the efficiency of hand-off report, I propose the development of a structured electronic hand-off tool. The electronic hand-off form will be a concise document found in the patients EHR (electronic health record) that the transferring clinician initiates. Critical information such as the patients’ vital signs, surgical site/procedure/dressing, ASA level, medical history, allergies, demographics, medications given, and Aldrete scoring will auto-populate from the data already documented in the patients’ EHR. The computer system will pull data from multiple different sources in the chart, such as the anesthesia pre-evaluation note, the vital signs flowsheet, and the intraoperative surgical note. Implementing this process will require the efforts of the information technology department, surgical and inpatient department supervisors, hospital education, and frontline staff of the perioperative department. The IT department will create the new system in conjunction with the electronic documentation “super-users” of the hospital. The nurse educators will partner with the supervisors for effective documentation training and proper use of the E-handoff report system. Substantial education and training are crucial to implementing the adequate use of the new e-handoff tool. Competency in communication is a fundamental element for nurses in the clinical setting. The training objective for perioperative employees should focus on educational information that provides background information about handoff communication, the regulations for the process of verbal report, the components of the handoff tool and the use of it, and the expected improvement outcomes.

    BENEFITS OF EFFECTIVE E-HANDOFF

• Consistency in communication
• Reduction of errors from incorrect and omitted information
• Eliminates redundancy and confusion
• Enhances the inclusion of vital details
• Provides more time for the nurse to ask questions and make suggestions to plan of care
• Encourages face-to-face patient handoff
• A decrease in surgical errors, length of stay, and unexpected costs related to ineffective communication

How the registered nurse is going to use the electronic system:

1. -        The nurse will log onto the patient documentation and open the “notes” section. When the clinician opens the notes section a series of notes options will appear, and the nurse will select the E-handoff report document.
2. -          Before starting the note, the computer will prompt the clinician with the option to “use information most recently recorded.” The clinician can accept the prompt and the systems will auto-populate information already documented in the chart and correctly fill it into the desired slots of the note.
3. -          The clinician will have the option to modify, update, and correct errors in the E-handoff note before signing it and sending it to the receiving clinician for review. Therefore, any information that may have been disregarded or missed in the note the nurse can make the necessary corrections.
4. -          Once the nurse has verified her note and that each slot for documentation is accurately filled with the appropriate information she will click the save button.
5. -          Saving the E-handoff document will prompt the nurse to “sign with sending.” This option will present a drop down box for the nurse to type in the name of the nurse that will be receiving the patient.
6. -          After saving, signing, and choosing the receiving nurse of the document the transferring clinician will click send.
7. The system will default to flag the chart, in the top margin, that an E-handoff note is ready for review for the specified receiving nurse. However, any nurse accessing the chart can review the note. Yet, the flag alert will not disappear from the top margin bar until the specified receiving nurse reviews the note. Once the receiving nurse opens the note for review, a small message box will pop-up to alert the nurse to sign the e-document to verify the note was received.

Subsequently, the E-handoff alert will disappear from the top margin box, and the note will convert to an official note of the patients’ EHR. The nurse can print the report sheet and use it as a reference at the bedside or include it in the patients’ physical chart. The nurse caring for the patient will still call the receiving nurse to inform her that her patient is on the way for transfer and this will allow time for the receiving nurse to be present in the patients’ room on arrival. 

E-handoff is a great way to include all of the details of the patient’s surgical stay. Nurses in the perioperative setting receive a report from multiple different clinicians such as surgeons, OR nurses, and anesthesia providers. The electronic handoff tool will contain all of the pertinent information charted by these healthcare professionals in one transferrable document. A charting system that doesn’t require the nurse to do much charting, but only to review that the auto-populated information is in the correct place for clarity is excellent. Perioperative nurses consistently voice their desire for simpler charting systems that enhance continuity of care. Nursing is evolving to a technology enhanced care environment. Technology and electronic documentation are powerful tools for enriching the communication practices of nurses. Healthcare professional must find ways to improve the technology we have and efficiently apply it to bedside practice. Therefore, I encourage healthcare organizations to implement the E-handoff tool for best communication practices during patient transitions through the surgical department.   

References

Allen, J., & American Society of PeriAnesthesia Nurses. (2014). Perianesthesia nursing standards, practice recommendations, and interpretive statements: 2015-2017 (2015-2017th ed.). Cherry Hill, NJ: American Society of PeriAnesthesia Nurses.

Ratcliff, K., Bond, S., Burke, J., Koop, C., Meyers, J., & Scherer, M. (2017). Improving Handoff. Journal of Perianesthesia Nursing, 32(4), e21. Retrieved from https://doi.org/10.1016/j.jopan.2017.06.081

Robinson, N. L. (2016). Promoting patient safety with perioperative hand-off communication. Journal of PeriAnesthesia Nursing, 31(3), 245-253. doi:10.1016/j.jopan.2014.08.144