Since the advent of resident hour restrictions in 2003, handoffs between providers have become increasingly prevalent. The process of handoffs can require a substantial amount of time depending on the number of patients being discussed, whether the handoff is in person, via telephone, or, by some other method. And while handoffs are occurring, other important tasks such as communication with nursing staff, electronic order entry, and patient evaluation are difficult to accomplish. To reduce the time spent on nightly handoffs from 7 ward teams to a single nocturnal covering provider, a triage system was developed to delineate less stable patients in need of discussion from more stable patients able to have pertinent information communicated through the hospital EHR.
To evaluate the feasibility and effect (time savings) of a triage system that identifies less stable patients in need of verbal handoff to a single nocturnal covering provider, from patients considered more stable and able to be handedoff through the hospital EHR.
An initial picture of the time spent on handoffs from ward teams to the nocturnal on call doctor (“OCD”) was achieved through the OCD’s report of starting times and end times for the process for 14 nights. Subsequently, a method for triaging patients to verbal check out or EHR based check out was developed: Four categories of patients were delineated: A= Acutely ill/unstable; B= Becoming stable; C=Consistently stable; D=Discharge pending. During the intervention, patients were triaged to one of these categories prior to the usual 7:00 pm checkout. Then, at checkout, “A” patients received a detailed verbal discussion between the day team provider and the OCD. “B” patients received a brief checkout focusing on the most pertinent details. Patients designated “C” and “D” were not checkedout verbally; but all pertinent information was to be included on a team’s handoff sheet contained within the hospital EHR. This system was implemented for two weeks, and again, OCDs reported the starting times and end times of nightly handoffs. Comparison of the average checkout times before and after the intervention showed a reduction from 72.9 minutes before the intervention to 56.8 minutes after the interventiona savings of 16.1 minutes or 22.1 %. Providers on both sides of these handoffs reported the process was straight forward and easy to use.
A triage system that identifies less stable patients in need of verbal handoff to a nocturnal covering provider, from patients who are more stable and able to be handedoff via an EHR based system is feasible and reduces time spent on handoffs by more than 20 percent.
To cite this abstract:Pentecost P. Pilot of a Triage System to Increase Efficiency in Handoffs Between Ward Teams and a Single Nocturnal Covering Provider in a Tertiary Care Teaching Hospital. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97690. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/pilot-of-a-triage-system-to-increase-efficiency-in-handoffs-between-ward-teams-and-a-single-nocturnal-covering-provider-in-a-tertiary-care-teaching-hospital/. Accessed May 26, 2019.