Failures in communication between healthcare personnel have been clearly implicated as a threat to patient safety. The transfer of accurate information about patients is fundamental to the provision of effective and safe patient care. We hypothesized that an electronic tool reflecting the most current patient information documented in the medical record and used to guide nurses' change-of-shift report would improve the quality of handoffs and reduce associated errors.
An electronic report tool was created by nurses representing a cross-section of clinical areas; the tool contains both prepopulated and free-text entries. This electronic tool was initially implemented on a pilot unit in preparation for wider distribution. To achieve a better understanding of report practices prior to the implementation of the tool, a survey, based on published work of Arora et al, was designed to identify the methods used by nurses to perform change-of-shift report, as well as to obtain their perceptions of time requirements, report quality, and errors associated with report. A repeat survey will be performed following implementation of the tool.
The baseline survey results provided broad support for the need of an electronic standardized report form. One-third of the nurses were able to recall an incident in which a poor-quality report had led to an unintended patient event. Two-thirds of these unintended events were the result of missing information. The primary recommendation for improving report was to computerize the report form to standardize content to reduce the likelihood of missing information, minimize transcription errors, ensure that information is current, and save nursing time in report preparation. Preliminary postimplementation feedback reflects improved satisfaction with report quality and a reduction in time to prepare report.
The development and implementation of an electronic report tool that leverages existing medical record documentation and is used as a reference while giving report are useful in improving quality of report and in reducing the time it takes to prepare and provide report. The electronic report can be used for patient transfer and downtime communication as well.
Electronic SBAR and Nursing Technology and Informatics Committee members; nursing staff of the GI and Surgical Oncology Unit; Donna Matras, RN, clinical coordinator; Karen Cabansag, RN, clinical manager; Michelle Janney, CNE; Carol Payson, director, Surgical Nursing; Corinne Haviley, director, Medicine Nursing; and Bin Shen, data analytics architect.
1. Arora V, Johnson J, Lovinger D, et al. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14:401-407.