Doctor of Nursing Practice Program
R. Leigh Mansfield, DNP, MS, AGACNP-BC
Committee Chair Name & Credentials:
K. Melissa Hayes, DNP, ANP-BC, CHFN
Committee Member Name & Credentials:
Sarah Gast, DNP, APRN, AG-ACNP-BC
DNP Project Abstract
Standardization of Electronic Note-Based Handoff Communication for Inpatient Practice
The purpose of this DNP quality improvement project was to implement a standardized electronic note-based handoff to be utilized between advanced practice providers during shift change for an inpatient cardiology service at an academic medical center. This project was implemented with a goal to determine if standardization of inpatient handoff can improve provider satisfaction, improve time efficiency, and reduce number of patients with missed information.
This project involved creating a standardized note-based electronic handoff tool tailored to the cardiology team and implementing the handoff standardization for a period of seven days. A pre-and post-intervention was completed separately for dayshift and night shift to analyze provider satisfaction, perceived time to complete, and missed information was completed to determine if the implementation of the standardized electronic note-based handoff tool was effective in improving provider satisfaction, improving time efficiency, and reducing number of patients with missed information.
Descriptive statistics were completed to determine pre- and post-intervention data for provider satisfaction, time to complete, and number of patients with missed information, captured both before and after implementation and expressed by team (dayshift vs nightshift). No improvements were noted in provider satisfaction for nightshift regardless of handoff standardization, but dayshift did note a minimal increase in provider satisfaction in the post-intervention period. Time to complete handoff rose slightly for dayshift while completing standardized handoff but decreased slightly for nightshift while reviewing the standardized handoff. When nightshift was reviewing handoff in both pre-and post-intervention periods there was no improvement noted in number of patients with missing information despite standardization. Overall, there was no significant improvements noted with implementation of standardized handoff but that may be due to limiting factors.
Implications for Practice
The handoff communication between providers is an essential part of the healthcare model. This practice is utilized when a patient is moving from the care of one provider to another for a variety of reasons, and versions of handoff happen multiple times a day on every patient in an inpatient setting. Given the increased utilization of APPs in the inpatient environment, more research is needed into the standardization of APP provider-to provider communication. Despite the overall lack of improvement in handoff given standardization, this project was a needed start in exclusively APP communication related research. With increases in implementation time and improvements in the healthcare environment this may have yielded different results.