Background: The American College of Graduate Medical Education requires resident involvement in patient safety and quality improvement (PS/QI) but it remains difficult to engage house officers (HOs) in meaningful and sustainable projects. In 2011, the University of Michigan created a multidisciplinary committee called the House Officer Quality and Safety Council (HOQSC). The goal of the HOQSC is to increase direct involvement of HOs in multidisciplinary institutional PS/QI work and leverage institutional resources to support those initiatives. Our hospital’s 2014-2015 Patient Safety Plan identified hand over improvement, particularly HO sign out, as a critical safety priority and the HOQSC took ownership of this task.
Purpose: This report aims to demonstrate the HOQSC’s successful evaluation of an institutional problem and implementation of an impactful PS/QI initiative.
Description: In March 2015, the HOQSC queried all HOs on hand over safety using a subset of questions from the Agency for Healthcare Research and Quality (AHRQ) Hospital Safety Culture survey and open-ended questions regarding satisfaction with and usability of our existing electronic medical record (EMR) sign out tools. Safety specific concerns identified were: variable functionality of the multiple tools, lack of standardization of tools used across services, limited user control over the amount and accuracy of free text and auto-populated information, inability to simultaneously view the chart and update the tools, format of the printed sign out, and lack of designated space for consultant sign out. Additionally, many services were using tools outside of the EMR (e.g. email) which risk HIPPA non-compliance. HOQSC representatives presented the findings to an institutional PS/QI committee where hospital leaders agreed to endorse and allocate resources to this project.
EMR specialists and HOs reviewed the survey results and deemed that existing options in our EMR were insufficient to address the concerns. HOs from medical and surgical specialties brainstormed with colleagues about an ideal sign out template for their service. Representatives then met and formed a consensus on layout and content of the tool. An alternative tool was found, added to our EMR platform and tailored to HOs recommendations. The final product contains a mix of pre-populated patient information and free text areas allowing the tool to be modified for individual services. It can be edited while viewing the patient chart to facilitate accuracy of information. Every service, including consultants, has access to a unique space for their sign out. User acceptance testing was performed to vet the design and dissemination of education around its use was done through email and peer-to-peer education. Since its launch, at least 25 services use the tool daily. HOs will be surveyed again this Spring to evaluate for improved satisfaction and continued enhancements are made to the tool to facilitate safer sign out of patient information.
Conclusions: The HOQSC is a valuable asset for the evaluation of institutional patient safety issues and engaging HOs in impactful PS/QI work to improve safety and efficiency of patient care workflow.
To cite this abstract:Levy, K; Heidemann, LA; Morrison, RJ; Thompson, M; Almendras, EG; Chang, R. ELECTRONIC MEDICAL RECORD SIGN OUT TOOL IMPROVEMENT PROJECT: A NARRATIVE DESCRIPTION OF THE EFFECTIVENESS OF THE UNIVERSITY OF MICHIGAN’S HOUSE OFFICER QUALITY AND SAFETY COUNCIL. . Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 185. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/electronic-medical-record-sign-out-tool-improvement-project-a-narrative-description-of-the-effectiveness-of-the-university-of-michigans-house-officer-quality-and-safety-council/. Accessed April 22, 2019.