Standardizing Patient Handoff from the Emergency Department to the Stepdown Inpatient Unit

Abstract

The standardization of the patient handoff has become more imperative with the ever-increasing implementation of the electronic health record. An area especially vulnerable for patient handoff failure is from the Emergency Department (ED) to a Stepdown Inpatient Unit. Based on two sentinel events in the community hospital , a quality improvement project was implemented to standardize the handoff tool used in the electronic health record, improve the nurse’s perception of the handoff process and decrease the time from ED bed assignment to arrival on the stepdown inpatient unit (SDIU). A lean process was used to analyze and evaluate the current process and implement the use of the electronic situation, background, assessment, and recommendation (eSBAR) tool. The findings were negligible with no improvement in the nurse’s perception of handoff, or time from the ED bed assignment to arrival on the SDIU. There were several gaps in utilizing the eSBAR tool, including each inpatient nurse, was required to add the handoff tool to their summary page manually. After completing the implementation of the project, the existing eSBAR needed further refinements, and several recommendations were made to the health care system.