Patient handoffs increase the likelihood of miscommunication — and ultimately medical errors — among hospitalized patients. The Joint Commission has recommended a standardized approach to patient handoff as part of its National Patient Safety Goals. Most commercial electronic health records (EHRs) lack effective tools to support patient handoff activities. As a result, many institutions employ “shadow” documentation processes that can lead to redundancy, information fragmentation, treatment delays, and medical errors.
To develop a standardized electronic tool for documenting and disseminating important handoff information that encourages collaboration and is fully integrated with a commercial EHR.
Our institution included 2 large academic medical centers with a fully deployed commercial EHR system. Because of the academic setting and the increasing number of hospitalists at each medical center, patient handoffs were frequent, Various paper and electronic processes were used by different groups within each medical center to communicate information at shift change. In early 2008, we developed a unified electronic handoff application that was integrated as a custom “tab” within our commercial EHR application. Clinicians used the Patient Handoff application to enter information such as “Patient Summary”, “Notes/Comments”, and “To Do” items for both primary and coverage teams. Other data from the EHR were automatically imported into the printed report, including patient demographics, allergies, medications, vital signs, and common laboratory tests. An example of a printed report for a single patient is shown in Figure 1. The contents of the printed report were customizable. For example, (1) users could specify which handoff and EHR data to include, based on the intended purpose of the report (e.g., handoff to covering physician, prerounding sheet); (2) the time window for laboratory results and vital signs was selectable; and (3) active medications, grouped by therapeutic class, could be displayed in an expanded or space‐saving, condensed, form.
The Patient Handoff application has been available to our clinicians since March 2008 and has been received with enthusiasm. The application has been used to enter handoff information for approximately 2400 unique patients each month. Of the 1631 clinicians who viewed handoff information at least once during December 2008, 47.0% were nurses, 38.4% were physicians/physician assistants/nurse‐practitioners, and 14.6% were medical students, pharmacists, social workers, or others. In December 2008, 12,582 handoff reports were created, which included information of the type shown in Fiqure 1, for 82,869 patients.
M. R. Fred, NewYork‐Presbyterian Hospital Information Systems, employment; D. K. Vawdrey, Columbia University Department of Biomedical Info, employment; D. M. Stein, Columbia University Department of Biomedical Info, employment; Stetson, PD, Columbia University Department of Medicine, employment.
To cite this abstract:Fred M, Vawdrey D, Stein D, Stetson P. Enhancing a Commercial Electronic Health Record with a Novel Patient Handoff Application. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 114. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/enhancing-a-commercial-electronic-health-record-with-a-novel-patient-handoff-application/. Accessed July 16, 2019.