When Kathleen Mikos, RN, MSN, CNO and vice president of patient care, 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—performing patient handoffs took longer than it should have. The lengthy amount of time became an issue with incremental overtime and also got in the way of patient care.
"I was concerned because during a period of an hour, where so many nurses are tied up, who is taking care of the patients?" says Mikos.
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. The old and the new There were also instances when the tape recorder broke or someone had recorded over a report, causing the nurses to take more time to rerecord each patient report. More recently, nurse-to-nurse interaction between shifts is how patient handoffs are handled. As the nightshift is coming on and the day shift is leaving, and vice versa, the nurses discuss each patient and how the shift went.
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.
Although effective, this process takes a lot of time, and many nurses go into overtime.
"Between shifts, 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. 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.
Voice technology OptiVox
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 uses his or her patients' medical record number in order to 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 to 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."
Advantages for the entire hospital
OptiVox received a positive reaction from patients, nurses, and the management team, says Mikos.
For the nurses, there are features in OptiVox that help make recording and listening to the reports easier and more convenient than listening to a normal tape recording.
The program gives the nurses the option to slow down or speed up a recording if the nurse who recorded the report is a fast or slow talker.
In addition, OptiVox provides the capability for nurses to go back to where they left off if they were interrupted while recording any reports.
The program also allows managers and nurse leaders to leave a broadcast message there for all staff members to hear.
"Typically, if there is something of importance that I need to get out, I can have that message presented for as many shifts and days as I believe necessary to penetrate my staff," says Mikos.
OptiVox is also beneficial to the nursing students that come through the Ingalls health system, says Mikos. The program allows the students to listen to reports and helps them become more acclimated to real-life situations, says Mikos.
Another benefit of this technology is that the records can be kept for any length of time, depending on how long the organization wants.
"We hold on to the records for two weeks," says Mikos.
By keeping the records for this length of time, Ingalls ensures that in the event of a near miss or an error, the report is on file and can be listened to again.
Involvement with other departments
The OptiVox technology is also beneficial when it comes to patient throughput and alerting an area of the hospital to expect a patient from the ED, says Mikos.
Prior to implementing the technology, ED nurses had difficulty reaching nurses on other floors and units.
"We tried all sorts of things, from bringing the patient up to a certain floor to attempting to keep calling back and forth," says Mikos.
Now, with OptiVox, when a nurse needs to transfer a patient from the ED to another unit, he or she simply voices the report into OptiVox and the system automatically sends a voice message to a designated unit telephone number. That patient's report is then available for the receiving nurse.
The ED nurse also includes his or her name and telephone number in the event the receiving nurse has any questions.
"This has really taken away the bottlenecks that were created when giving reports," says Mikos. "This gives us a precise process to user report and helps expedite the patients out."
Savings and positive thoughts
One of Mikos' goals when implementing the new technology was decreasing incremental overtime. "With the new process, we saw a great reduction in overtime," she says. "And the savings helped pay for the technology."
However, Mikos warns that there has to be a strong message sent from the leadership team about incremental overtime and backing the system.
"There are some nurses that aren't so in tune with us managing incremental overtime," says Mikos. "You have to monitor the time and send a message so no one resorts back to the old ways of recording incremental overtime."
Overall, Ingalls staff members have been pleased with the new handoff process, and even the unit secretaries noted how much the noise level decreased, Mikos says.
Once, the halls were filled with nurses chattering, trying to catch up on reports. Now, the halls are noticeably more quiet because nurse-to-nurse communication for handoff reports has been replaced by telephones and computers, says Mikos. "The healing environment has improved tremendously."
This article was adapted from one that originally appeared in the December 2009 issue of Patient Safety Monitor (Briefings on Patient Safety), an HCPro publication.