When Kathleen Mikos, RN, MSN, vice president of patient care, chief nursing officer, came to Ingalls Memorial Hospital in Harvey, IL, she couldn't shake the sense of déjà vu when she found that patient handoffs took an hour to 90 minutes to complete.
At her previous hospital, Mikos had dealt with a similar issue. The lengthy amount of time became an issue with incremental overtime and also got in the way of patient care.
Drawing on her past experience, in May 2008 Mikos began to develop a new, efficient method for patient handoffs that allowed for more patient/nurse interaction and reduced nurse overtime at Ingalls.
For years, nurses nationwide have used different methods for handling handoff reports. One technology was the use of taped records. This caused problems because if an interruption occurred while the nurse was reporting, the nurse had to make a note on the recorder where the tape left off, causing confusion later on.
There were also instances when the tape recorder broke or someone had recorded over a report, causing the nurses to take more time to re-record each patient report.
More recently, handoffs involved nurse-to-nurse interaction between shifts. As the nightshift was coming on and the day shift was leaving, and vice versa, the nurses discussed each patient and how the shift went.
Although effective, this process takes a lot of time, and many nurses went into overtime at Ingalls.
"Between shifts, as 10 nurses are coming on and 10 nurses are leaving, I can have up to 20 nurses tied up," says Mikos. "Having that many nurses tied up, trying to get reports, cuts into the patient care."
Much of the delay occurred because not all nurses shared the same patients. Most of the time, those nurses who were starting their shifts had to track down the nurses who had their patients during the previous shifts.
To solve this problem, Mikos turned to The White Stone Group, Inc., for a technological solution to facilitate a new handoff process. This company provides healthcare organizations with software to help improve the management of healthcare communication events.
Having had experience with The White Stone Group in the past, Mikos was confident in setting up OptiVox, a voice technology program for handoffs, and made the program accessible to all staff members through any telephone in the hospital system.
Other similar programs that facilitate the patient handoff process include the PatientKeeper Sign-Out technology and Vocera's communication systems. Physicians use the PatientKeeper program as a continuity of care tool and enter patient care details that the next shift's physician will need. Vocera's wireless devices enable instant communication among staff members.
OptiVox is a computer-based voice platform technology that is built into the phone system, says Mikos. Nurses can dial into OptiVox and record their patient reports, or listen to the patient reports from any phone in the health system.
Nurses coming off a shift and needing to report on their patients dial in an individual access code, pull up each patient's medical record number, and begin recording a report on that patient.
In addition to using OptiVox to record their reports, the nurses are also encouraged to use the SBAR format. The SBAR technique helps guide communication between staff members on a patient's condition.
To identify each patient in the system, Ingalls uses the patient's medical record number to prevent confusion, says Mikos.
"You are always up against potential patient safety issues, and some patients may have the same name or date of birth, but medical record numbers are always going to be unique," says Mikos.
When nurses arrive to start their shifts, they can access the reports from the previous shift the same way nurses record them. Using any phone in the health system, the nurse dials in with an individual access code and using his or her patients' medical record number; the nurse can then listen to the reports.
"To receive reports on five or six patients should take about 15-20 minutes of shift report time," says Mikos.
Now, with extra time, the nurse can find the previous shift nurse, clear up any unanswered questions, and visit his or her patients for brief assessments and introductions.
"Here at Ingalls, we believe there is a need for face-to-face, or bedside rounding," says Mikos. "After the nurses [listen to the] handoff report, they should immediately go out to their patients, introduce themselves, and have a brief discussion on how the previous shift went."