Don t Fumble the Handoff! Tackling Effective Communication Courtney Gould, RN, BSN (MICU) Lisa Nolan, RN, AD (SICU) Kate Shaw, RN, BSN (Emergency) Nicole Howley, RN, BSN (Emergency)
South Shore Hospital
Purpose and Goals To improve communication, build better relationships, and build teamwork between the Emergency Department (ED) and the Intensive Care Units (ICUs) To have uniform use of Situation, Background, Assessment, and Recommendation (SBAR) format To decrease systems barriers, so more handoffs are completed with courtesy and mutual respect To see improved responses on nursing satisfaction survey
Purpose and Goals To improve patient safety as evidenced by a decrease in incident reports directly related to handoff miscommunication To reduce readmissions and length of stay, as well as potential legal costs AORN Institute of Medicine reports that costs associated with medical errors is $8 billion to $29 billion annually ($8,750 per patient) and that communication issues are the leading factor in most cases
Specific Activities and Key Dates November 15, 2012 The first meeting; we decided that first day we were very creative, and we were going to be a winning team!
Specific Activities and Key Dates January 2013 Dominance, Influence, Steadiness, and Conscientiousness (DiSC) assessment; we realized we have different strengths and skills
Action Plan February 2013: Spent a day in each others' shoes May 2013: Attended NTI in Boston as a team June 2013: Developed a fun slogan and PowerPoint; began to plan our mixer August 2013: Video developed to create awareness
Action Plan September 2013: Weekly e-mails sent to promote mixer and build momentum October 2013: Social mixer held for team building November 2013: Reinforced the use of the SBAR and importance of mutual respect Ongoing: Cross-training for new employees
What is the problem or breakdown in the process? Errors occur during handoff that directly impact patient safety Lack of understanding of workload, workflow, and priorities between the ED and ICU No formal structure of report and handoff from ED to ICU Strained relationship between the 2 areas
Why Standardize Communication? Focus on the patient not the people Standardized format allows staff to have common expectations What is going to be communicated? How will the communication be structured? What are the required elements?
Why Standardize Communication? S: Situation Patient age, gender, mental status, stable/unstable B: Background Pertinent medical history, allergies, sensory impairment, family location, religion/culture, interpreter if needed, valuables A: Assessment Vital signs, isolation/precautions, risk factors, issues of concern R: Recommendation Specific care required immediately/soon, priority areas (pain control, IV, family concerns)
What Do We Know About the Problem? South Shore Hospital ED has the second-highest volume of patients in the state of Massachusetts Nurses trying to give and receive report have frequent interruptions Heavy volume of patients and workload makes nurses feel rushed and unable to dedicate time for handoff they cannot address all important issues
May 2013: SurveyMonkey Sent to Staff
ICU Survey Please complete this quick checklist after report and patient transfer from the ED: 1. Did you have to call the ED nurse back to receive report? 2. Was report given in SBAR format? 3. Were there any questions you asked able to be answered by the ED RN? 4. Did you review the special panels page or any other patient information online before or during report? 5. Did the nurse you received report from transfer the patient to the unit themselves? 6. Did the patient arrive to the ICU as you expected from the report you were given? 7. Did you greet the patient in the room upon transfer from the ED?
Question 1 Question 2 Question 3 Question 4 Question 5 Question 6 Question 7 ICU Survey Results 100% 75% 50% Yes No 25% 0%
ED Survey Please complete this quick checklist after report and patient transfer to the ICU: 1. When you called the ICU to give report, were you connected to the nurse the first time? 2. Did you follow the SBAR format when giving report? 3. Were you interrupted at any point giving report by the receiving RN? 4. Were you able to answer all questions asked by the receiving RN? 5. Did you as the primary RN accompany/transfer the patient to the unit? 6. Were you met in the room by the primary RN receiving the patient?
Question 1 Question 2 Question 3 Question 4 Question 5 Question 6 ED Survey Results 100% 75% 50% Yes No 25% 0%
Key Challenges to the Project This was a challenging topic for data collection; not easy to quantify a culture change Juggling 4 schedules, and trying to make time Getting staff to buy in and agree with our plan; there was much resistance early on Our ICU manager left the organization High volume of patients and exceptionally high acuity in the ED and the ICUs Culture changes can be slow and difficult
Unintended Positive Outcomes to Date We have become great friends. It is very difficult to be rude or inconsiderate to a great friend. This is our hope of secondary gain for all of our coworkers through our work, the mixer, and our reinforcement. The initial Survey Monkey was responded to by 30% of staff which was encouraging to us! We have learned through research and group discussion with the other CSI groups how very critical communication is. Miscommunication is responsible for 60% to 70% of all sentinel events! There is increased awareness to communicate with the RNs on the opposite floor when giving report.
How Do We Plan to Maintain and Sustain the Project? Continue to build relationships between ICU and ED by encouraging the hospital to allow for a few hours of orientation devoted to visiting and working on the other unit. Continue to encourage staff to use the SBAR format during handoff. Continue to encourage staff to transport patients between units themselves to allow for relationships to form between nurses and to ensure patient safety. Encourage our current leadership to include the handoff video as part of our current mandatory skills days each year.
Fiscal Impact AORN reports costs associated with medical errors is $8,750 per patient We had 10 incident reports that were related to handoff in the month of November 2012 and zero incident reports related to handoff in the month of February 2014 $8,750 x 10 incident reports = $87,500 per month $87,500 x 12 months = projected annual savings of $1,050,000
Fiscal Impact AORN reports costs associated with medical errors is $8 billion to $20 billion annually ($8,750 per patient) and that communication issues are the leading factor in most cases. Patient safety initiatives PRICELESS
Special Thanks To AACN and the CSI Academy: Susan Lacey, RN, PhD, FAAN, Program Director, AACN CSI Academy Dave Hanson, RN, MSN, ACNS-BC, NEA-BC, AACN CSI Academy Boston Lead Faculty Adrienne Olney, AACN CSI Academy Program Manager To South Shore Hospital: Timothy Quigley, RN, MBA, Chief Nursing Officer Donna Chase, RN, MHA/MS, Director Accreditation/Clinical Professional Development & CSI Coach
Lastly we would like to thank the staff on our units for their dedication to our patients and families and all of the support shown to us with this project!
References 1. Caple, C. Hand Off : Patient Safety. Evidence Based Care Sheet. 2012. 2. Iacono, MV. Handoff Communication: Opportunities for Improvement. Journal of PeriAnesthesia Nursing. 2009;24(5):324-326. 3. Murray, A. How to Change Your Organization s Culture. The Wall Street Journal. 2009. 4. Woods, MS. Effective Handoff Communication, Part 1. Developing and Improving New SBAR Tool. The Joint Commission Perspectives on Patient Safety. 2010; 10(10):3-5,11. 5. Conaboy, C. Children's Hospital creates system for safe patient handoffs: Researchers map stately to reduce errors. The Boston Globe. 2013. 6. AORN. Standardizing Hand Offs for Patient Safety. AORN.org. 2013.
Play Communication/Handoff Video of South Shore Hospital CSI Team
Questions?