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Electronic Health Record (EHR) integration is extremely relevant in today’s modern world, with all practice management being conducted via software. As your patient management and treatment relies on your patient information, EHR integration is a big factor when determining the best practice management solution to use and is a key component of ensuring personal health information (PHI) is kept safe.
To help you understand what electronic medical records (EMR) is and why it’s so important to your practice, we explain what EHR integration is, as well as show you how it will help you acquire new patients, help you retain existing patients, enhance the patient experience, and drastically improve your patient management and processing.
Patient handoff tool
The increasing fragmentation of health care has the unintended consequence of more care transitions. Transitions of patient care between providers occur frequently and require providers to transmit critical clinical information. If information is omitted or misunderstood, there may be serious clinical consequences . Several studies have shown that handoffs are often variable and represent a major gap in safe patient care .
In addition to care transitions into and out of the hospital (extra-hospital handoffs), hospital care itself has become increasingly fragmented due to the increase in number of resident handoffs secondary to duty-hour regulations and the adoption of the shift-work type systems utilized by hospitalists. In-hospital handoffs are common in hospitals and represent a vulnerable time during patient care. For example, hospitalized patients are often passed between doctors an average of times during a single five-day hospitalization .
Poor handoffs lead to uncertainty during clinical decision-making, which then leads to potential harm (near misses) and inefficient work in both resident and hospitalist service changes . Handoffs between levels of care, such as critical care to floor, or operating room to post-anesthesia care unit (PACU), also represent potential for information loss and communication failure.
Using handoff tool for right patient identification
irst one needs to recognize the term “handoff” and synonymous terms that are used in a wide variety of contexts and clinical settings. There are a number of terms used to describe the handoff process, such as handover,1, 13, 14 sign-out,15, 16 signover,17 cross-coverage,18, 19 and shift report.20–22 For the purpose of this discussion, the term “handoff” will be used and defined as, “The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm”23 (p. 31). The concept of a handoff is complex and “includes communication between the change of shift,
communication between care providers about patient care, handoff, records, and information tools to assist in communication between care providers about patient care”1 (p. 1). The handoff is also “a mechanism for transferring information, primary responsibility, and authority from one or a set of caregivers, to oncoming staff”17 (p. 1). So, conceptually, the handoff must provide critical information about the patient, include communication methods between sender and receiver, transfer responsibility for care, and be performed within complex organizational systems and cultures that impact patient safety. The complexity and nuance of the type of information, communication methods, and various caregivers for each of these factors impact the effectiveness and efficiency of the handoff as well as patient safety.
Implementing a perioperative handoff tool to improve postprocedural patient transfers.
Handoffs in the perioperative setting–the period during which the patient leaves the operating room (OR) and arrives at the postanesthesia care unit (PACU) or intensive care unit (ICU)–have received little attention. A perioperative handoff tool consisting of an OR-to-ICU/PACU protocol and checklists incorporates a defined process, a specified team structure, a procedure for technology transfer, and clearly defined information elements to share. The tool could be applied to any periprocedural setting in which a patient is physically transferred from the procedural location (with the associated procedural team) to a postprocedural care unit with a different care team.
Tool shared to handoff patient
The surgical services shared governance staff leadership council at NCH hasused the SHARED model to create a communication tool for handoffs as part of itseffort to improve interdepartmental communication (form, p 16).
“It was helpful for us to have our shared governance council involved in creationof this tool because the staff perceived it as an extension of their own ideas ratherthan just another form to fill out,” says NCH’s director of surgical services, JudithKnupp, RN, MA.The entire council had input into the tool, and input was gathered from otherstaff as well, notes Jill Moscato, RN, APN, OR advanced practice nurse.
Important to acceptance, along with staff input and buy-in, was having nursesand other staff members explain the tool to each other, rather than just putting theform on the chart, says Knupp.Filling out the SHARED tool is not the same as documenting in a chart. “TheSHARED report is simply a work sheet to help the staff organize their report to othercaregivers and not a permanent part of the patient’s record,” she emphasizes. The report is discarded at the end of the patient’s surgical experience.
“It’s important to understand that we don’t separate each part of this report to acertain surgical department—nurses in each department fill out as much as possible,” she adds. “The purpose is to communicate information that is significant or ofinterest about the patient and share a unified report.”
Best practice patient handoff tool
While controversy exists regarding the number of patient deaths that result from medical errors annually,1,2 experts agree this is a significant problem in healthcare.3,4 The Joint Commission reported communication failures as the root cause of most sentinel events.5 Approximately half of these communication failures occur during patient handoffs, which are pervasive in current healthcare systems. Studies in teaching hospitals have documented 4,000 patient handoffs per day.6 Clinicians across all disciplines regularly participate in some form of patient handoff or transition of care. Effective handoff communication skills need to be systematically taught, but few clinicians receive formal handoff education during training.7
Structured patient handoff processes can improve the fidelity of communication. Earlier studies showed that training clinicians to provide structured patient handoffs increased clinician comfort and patient information retention.More recently, a landmark paper by Starmer et al9 reported improvements in patient safety through handoff standardization. Their study used rigorous methodology to demonstrate that the use of a structured handoff communication program, I-PASS, led to a 23% reduction in medical errors and a 30% reduction in preventable adverse events (AEs) among residents physicians at 9 pediatric hospitals.
