Improving Handoff Between Emergency Room Nurses and Medical-Surgical Nurses by Kiuana Crawford https://padlet.com/Kcrawfo7/nkovq4brae8por7 NURS 585: Dana Miller-Cintron, Daniel Morales, Joy Altabano, Chandra Racer, Kiuana Crawford en-us 2022-11-07 04:34:54 UTC 2026-02-13 13:17:07 UTC hello@padlet.com Introduction: The Importance of HandOff Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372429852
Handoff report is performed when the transferring nurse relays important information to the receiving nurse. It may include:
  • Reason for Admission
  • Relevant History
  • Plan of Care
  • IV access
  • Medications given
  • Test results, and more. 
Currently in Lakeland Regional Hospital, there is not currently any form of handoff report technically required between the ER and Med-Surg units. 

This can delay care, leaves room for errors, and is a patient safety risk.

]]> 2022-11-07 04:56:35 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372429852 Our Project and Its Purpose Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372432956 The primary focus of this project is to operationalize a standardized handoff communication format for the emergency department and medical-surgical units. 


A workflow issue resolution is needed to produce a more effective handoff report during these patient transfers.  By having a standardized and effective handoff report that includes all necessary components, there is considerably improved patient care when the patient arrives at the Med-Surg unit.
]]> 2022-11-07 04:59:16 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372432956 Project Description Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372434592 This project will focus on implementing an electronic SBAR (eSBAR) handoff report for ER nurses and med-surg nurses to utilize with the med-surg patients. The eSBAR that can be used will be the patient summary, an existing tool within the EHR system. 


By providing a common language tool for communicating relevant patient information, staff can thoroughly communicate essential patient data, information, and knowledge to ensure the safe continued continuity of care and significantly decrease the breaches in patient safety during the transfer of care, and aid in reaching the goal of safe patient communication and improving handoff communication (McGrath et al., 2020). 
]]> 2022-11-07 05:00:47 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372434592 Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372440437 Research shows that the information for handoff reports between the ER and Med-Surg units is not standardized nor consistent. This leads to a huge impact on the safety and flow of patient care. Having a standardized report process can result in a focused reliable information being passed along and less chance of critical information being missed (Sermersheim et al., 2020). ]]> 2022-11-07 05:05:57 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372440437 The Result of Poor Handoff Communication Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372449293 2022-11-07 05:11:21 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372449293 References Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372463882 Aronson, T. M., Oertle, S. E., & Piscotty Jr., R. J. (2021). Key characteristics of a successful EHR-supported e-handoff tool: A systematic review. Online Journal of Nursing Informatics, 25(1), 4–1.

McGrath, J. K., Elertson, K. M., & Morin, T. (2020). Increasing patient safety in hemodialysis units by improving handoff communication. Nephrology Nursing Journal, 47(5), 439–446. https://doi.org/10.37526/1526-744X.2020.47.5.439

Potts, L., Ryan, C., Diegel-Vacek, L. & Murchek, A. (2018). Improving patient flow from the emergency department utilizing a standardized electronic nursing handoff process. JONA: The Journal of Nursing Administration, 48 (9), 432-436. doi: 10.1097/NNA.0000000000000645


Sermersheim, E. R., Moon, M. C., Streelman, M., McCullum-Smith, D., Fromm, J., Yohannan, S., & Powell, R. (2020). Improving patient throughput with an electronic nursing handoff process in an academic medical center: A rapid improvement event approach. The Journal of Nursing Administration, 50(3), 174–181. https://doi-org.ju.idm.oclc.org/10.1097/NNA.0000000000000862

Uhm, J.Y., Lim, E.Y., & Hyeong, J. (2018). The impact of a standardized inter-department handover on nurse’s perceptions and performance in Republic of Korea. Journal of Nursing Management, 26(8), p. 933-944. https://doi.org/10.1111/jonm.12608

]]> 2022-11-07 05:23:14 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372463882 Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372478234 Similar studies done using this process have led to quicker movement of patients from ER to med-surg units, which in turn frees up the ER nurses for more critical patients and allows more timely administration of live-saving antibiotics and pain medications (Potts et al., 2018).]]> 2022-11-07 05:35:50 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372478234 Article: Positive Impacts of Electronic hand-off systems designs on Nurses’ communication effectiveness Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372484784 2022-11-07 05:38:14 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372484784 Additional Benefits Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372499561 Additional Benefits from the creation and implementation of the standardized handoff communication tool include the tracking of outcomes from handoff reporting between the ER and the med-surg units such as:
  • Equipment-related issues
  • Transfers of unstable patients or patients not proper for transfer
  • Instances of isolation precautions not being communicated
  • Rapid responses within 12 hours of admission or unplanned ICU transfer within 12 hours of admission.

]]> 2022-11-07 05:51:40 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372499561 Project Justification Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372502961 Handoff report communicates vital information regarding the plan and health status of a patient to ensure a continuity of care throughout a patient’s hospital stay. Miscommunication between healthcare providers such as inaccurate documentation of patient care or experiencing limited availability of patient information in the EMR, can lead to breaches in patient safety and produce negative impacts on a patient’s health status as well as the hospital organization itself. 

Examples of these impacts include
  • Inaccurately monitoring a patient’s health status over time improperly treating a patient's ailments and diseases
  • Sentinel events
  • Disruption the continuity of care a patient receives 
  • Improper payments from CMS due to missing or inadequate documentation (Hailey, 2021)
]]> 2022-11-07 05:54:49 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372502961 Process Scope Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372508690 The scope of this project will focus on the handoff process from the emergency room to medical surgical units.  This includes intake forms in the EHR, nurse to nurse reporting, and the policies  and workflows surrounding this process.  The first step would be to find out what staff should be included in the project and the final step would be evaluating metrics and seeing if the change has led to better results.]]> 2022-11-07 06:00:29 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372508690 Current Metrics for The Project Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372511585


]]> 2022-11-07 06:03:04 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372511585 Metric #1: Standardized structure (eSBAR) and content for handoff reports that is incorporated in the patient’s electronic health record (EHR). Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372514158
Goal: utilize a standardized format for a smoother flow of information between ER nurses and Med-Surg nurses with a rate of 100% improvement.

A survery and Likert scale will be used to measure the satisfaction rate from ER and Med Surg nurses in using the standardized format (eSBAR) for handoff reports that is integrated in a patient's EHR. ]]> 2022-11-07 06:05:16 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372514158 Metric #2: Improve accuracy of information between ER nurses and Medical-Surgical nurses. Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372517963 Goal: accurate and complete handoff reporting of patient’s care received in the ER department with 0% errors or missed items.

Percent error will be determined through a pop-up checklist that is provided to the receiving nurse or the Med-Surg while receiving the report. Missed reports are considered as errors.]]> 2022-11-07 06:08:59 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372517963 Metric #3: Compliance to the standardized format in delivering handoff reports from ER nurses. Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372524378 Goal: 100% compliance rate of ER nurses.

This will be measured by tracking the number of times in which the nurses make use of the standardized handoff format which is merged in the patient's EHR. This will be automatically computed once the ER nurses opens the window or tab for the standardized handoff report in the patient’s EHR.]]> 2022-11-07 06:15:14 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372524378 Benefits of Internal and External Customers Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372532623 Internal: ER and Med-Surg Nurses
  • Handoff reports are quick, efficient, and safe.
  • Easier and quicker identification of important patient information
  • Allows for prompt intervention if patient's level of care needs transfer to more appropriate unit

External: Patients

  • Decreased boarding times in the ER and increases continuity of care (Aronson, et al., 2021)
  • Increased direct patient care (Aronson et al., 2022).
  • Increased patient satisfaction
]]> 2022-11-07 06:23:42 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372532623 Project Specifics Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372536910 The team working on this project will include the ER nurse manager, a group of 5 ER nurses, 5 medsurg nurses, at least 3 medsurg managers, 3 superusers, two nurse informaticists, IT manager, a nurse educator, and two people from administration. 

  • ER nurse(s) test out new product and give feedback
  • ER Nurse Manager to share relevant information to staff regarding training 
  • MS Nurse(s) test out new product and give feedback
  • MS nurse Managers share relevant information to staff regarding training 
  • IT Leader to focus on the design, redesign, troubleshoot any issues along the way
  • Superuser(s) to test the first versions of new product and to train users


The project start date is October 1st , 2022. The projected project charter approval date is October 20th, 2022. The intended project completion date is November 13th, 2022. 
]]> 2022-11-07 06:28:12 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372536910 Article: Reflecting On The Communication Process in Healthcare Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372544257 2022-11-07 06:35:44 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372544257 Analysis of Current Workflow Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372546246 Currently, when a non-critically ill patient enters the ER information is gathered from various sources and placed in the EHR.  When the patient is then admitted, the ER RN then fills out a transfer form that includes limited information.  The ER RN then may call the med-surg RN to give a handoff report, but this is not required. The med-surg RN must then go through the EHR to find out necessary important information. This process can be time consuming and cumbersome.  ]]> 2022-11-07 06:37:48 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372546246 Workflow Changes Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372546605 Goal: Be less disruptive as possible to the current ER workflow via enhancing the EHR’s ability to bring information from multiple sources into one SBAR form that the ED RN must use to provide a full handoff report to the Med-Surg RN. ]]> 2022-11-07 06:38:10 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372546605 Future State Workflow Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372547583 The ED RN using the new SBAR tool instead of the transfer form within the EHR. The ED RN will then call a report to the med-surg nurse with the SBAR tool to ensure key safety points are not missed during the handoff process.]]> 2022-11-07 06:39:04 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372547583 Analyzation and Refinement Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372558717 An analysis of their workflow process and handoff process is crucial to understand how both operate in their current form, and this can be done through process mapping. Once all areas have been identified and evaluated, the next step will be for the team to address the issues found and collaborate on the refinement of the processes, which includes  removing the steps that have a negative impact on the processes and/or steps that have no negative or positive impact at all as well as the collaboration between all team members who will use the process in their daily operations to determine what high optimization of these processes resembles and what adjustments are needed to create that visual. ]]> 2022-11-07 06:50:12 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372558717 Process Mapping and Its Benefits Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372575232 2022-11-07 07:06:09 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372575232 Testing New Workflows and Processes Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372587355 New workflows and processes should be tested by constructing a diagram or map for the new design to be implemented.  After this design is tested, it may be necessary to tweak changes until the desired handoff report is found. The needs of the healthcare organization will need to be consistently evaluated as well as the readiness of the team to implement the new changes. Workflows and processes may need to be tested and redesigned multiple times as the needs of the organization change in order to achieve the desired handoff that is beneficial.  ]]> 2022-11-07 07:16:56 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372587355 Training Individuals On New Workflows and Processes Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372590378
Individuals will be trained on the new workflows and processes in a series of online and live in-person classes hosted by certified, experienced employees.  The in-person classes will include “mock” handoff reporting between nurses and the related outcomes.  Necessary adjustments will be made to parts of the training processes to help employees with different learning methods and/or arrange for employee input and modify training as needed. 


]]> 2022-11-07 07:19:46 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372590378 Managing The ‘Go live’ With New Workflows Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372594278 To manage the “go-live” of this new workflow, there will be additional nurses available (superusers) as well as some IT members available to answer any questions or concerns mentioned by the nursing staff. There will be an online resource guide with videos tutorials and simulated EHR systems to practice with as well as printed resource guides posted in several locations throughout both units. Both guides will have visuals and common questions and answers posted as well as contact information if any concerns arise.]]> 2022-11-07 07:23:14 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372594278 Article: Implementing a New EMR. How Should We Train the Staff? Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372597576 2022-11-07 07:25:59 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372597576 Conclusion Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372601824 An effective standardized handoff reporting is part of the patient care through the transition of critical information and serves as a basis for the continuance of medical services. Furthermore, it is associated with increased patient safety and staff satisfaction and improvement in clinical performance (Uhm, et al., 2018)

While the following the objectives, metrics, process analysis, and implementation of the new workflow design addresses the loopholes in communication between ER nurses and Med-Surg nurses, detecting and preventing occurrence of errors along the workflow process will require an ongoing assessment and surveillance for further development. ]]> 2022-11-07 07:29:38 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372601824 Discussion Questions Kcrawfo7 https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372616426 1. .  What are your top concerns regarding bedside shift report between the ED and med-surg units, and how would you improve on these?

2. Do you agree or disagree to incorporate eSBAR hand-off with the patient's EHR? Justify your answer.



]]> 2022-11-07 07:41:11 UTC https://padlet.com/Kcrawfo7/nkovq4brae8por7/wish/2372616426