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

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97690

Background:

Since the advent of resident hour restrictions in 2003, hand–offs between providers have become increasingly prevalent. The process of hand–offs can require a substantial amount of time depending on the number of patients being discussed, whether the hand–off is in person, via telephone, or, by some other method. And while hand–offs 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 hand–offs 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.

Purpose:

To evaluate the feasibility and effect (time savings) of a triage system that identifies less stable patients in need of verbal hand–off to a single nocturnal covering provider, from patients considered more stable and able to be handed–off through the hospital EHR.

Description:

An initial picture of the time spent on hand–offs 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 check–out. Then, at check–out, “A” patients received a detailed verbal discussion between the day team provider and the OCD. “B” patients received a brief check–out focusing on the most pertinent details. Patients designated “C” and “D” were not checked–out verbally; but all pertinent information was to be included on a team’s hand–off 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 hand–offs. Comparison of the average check–out times before and after the intervention showed a reduction from 72.9 minutes before the intervention to 56.8 minutes after the intervention—a savings of 16.1 minutes or 22.1 %. Providers on both sides of these hand–offs reported the process was straight forward and easy to use.

Conclusions:

A triage system that identifies less stable patients in need of verbal hand–off to a nocturnal covering provider, from patients who are more stable and able to be handed–off via an EHR based system is feasible and reduces time spent on hand–offs 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.

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