Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis, Joshua; Riesenberg, Lee Ann; Mardis, Matthew; Donnelly, John; Benningfield, Branden; Youngstrom, Mallory

doi:10.4300/jgme-d-14-00205.1

Cited by 33 publications

(30 citation statements)

References 49 publications

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“…As other reviews of these topics have found, 24,47,48,56,79,84,89,[95][96][97][98]112,116 there is a mixed picture with regard to study results in all four interventions. There are a number of possible explanations for this.…”

Section: Limitationsmentioning

confidence: 88%

“…The majority of studies in the four systematic reviews found that handover tools were associated with an improvement in at least one outcome ( Tables 8 and 9). [95][96][97][98] Examples of improvements included decreases in the number of dropped tasks, the number of omissions, the number of preventable adverse events and LOS. However, there were also a small number of studies that reported an increase in the number of unexpected changes in care and the number of errors attributed to handover.…”

Section: Standardised Handover Toolmentioning

confidence: 99%

“…Whether or not this translates into better patient outcomes is not known; despite the majority of studies showing a positive benefit, most of the studies were of poor quality and were small, uncontrolled before-and-after studies. [95][96][97][98][100][101][102][103][104][105][106][107][108][109] Continuing education is the most challenging of the four interventions to assess in terms of the quality and quantity of evidence available. There is some evidence of improved knowledge and self-reported confidence in a range of skills, as well as in process measures, such as frequency of observations, but the evidence for improved patient outcomes is weak.…”

Section: Main Findingsmentioning

confidence: 99%

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Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Hogan

Hutchings

Wulff

et al. 2019

Health Serv Deliv Res

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BackgroundUnchecked patient deterioration can lead to in-hospital cardiac arrest (IHCA) and avoidable death. The National Cardiac Arrest Audit (NCAA) has found fourfold variation in IHCA rates and survival between English hospitals. Key to reducing IHCA is both the identification of patients at risk of deterioration and prompt response. A range of targeted interventions have been introduced but implementation varies between hospitals. These differences are likely to contribute to the observed variation between and within hospitals over time.ObjectiveTo determine how interventions aimed at identification and management of deteriorating patients are associated with IHCA rates and outcomes.DesignA mixed-methods study involving a systematic literature review, semistructured interviews with 60 NHS staff, an organisational survey in 171 hospitals and interrupted time series and difference-in-difference analyses (106 hospitals).SettingEnglish hospitals participating in the NCAA audit.ParticipantsNHS staff (approximately 300) and patients (13 million).InterventionsEducation, track-and-trigger systems (TTSs), standardised handover tools and outreach teams.Main outcome measuresIHCA rates, survival and hospital-wide mortality.Data sourcesNCAA, Hospital Episode Statistics, Office for National Statistics Mortality Statistics.MethodsA literature review and qualitative interviews were used to design an organisational survey that determined how interventions have been implemented in practice and across time. Associations between variations in services and IHCA rates and survival were determined using cross-sectional, interrupted time series and difference-in-difference analyses over the index study period (2009/10 to 2014/15).ResultsAcross NCAA hospitals, IHCAs fell by 6.4% per year and survival increased by 5% per year, with hospital mortality decreasing by a similar amount. A national, standard TTS [the National Early Warning Score (NEWS)], introduced in 2012, was adopted by 70% of hospitals by 2015. By 2015, one-third of hospitals had converted from paper-based TTSs to electronic TTSs, and there had been an increase in the number of hospitals with an outreach team and an increase in the number with a team available at all times. The extent of variation in the uses of educational courses and structured handover tools was limited, with 90% of hospitals reporting use of standardised communication tools, such as situation, background, assessment and recommendation, in 2015. Introduction of the NEWS was associated with an additional 8.4% decrease in IHCA rates and, separately, a conversion from paper to electronic TTS use was associated with an additional 7.6% decrease. However, there was no associated change in IHCA survival or hospital mortality. Outreach teams were not associated with a change in IHCA rates, survival or hospital mortality. A sensitivity analysis restricted to ward-based IHCAs did not alter the findings but did identify an association between increased outreach team intensity in 2015 and IHCA survival.LimitationsThe organisational survey was not able to explore all aspects of the interventions and the contextual factors that influenced them. Changes over time were dependent on respondents’ recall.ConclusionsStandardisation of TTSs and introduction of electronic TTSs are associated with a reduction in IHCAs. The apparent lack of impact of outreach teams may reflect their mode of introduction, that their effect is through providing support for implementation of TTS or that the organisation of the response to deterioration is not critical, as long as it is timely. Their role in end-of-life decision-making may account for the observed association with IHCA survival.Future workTo assess the potential impact of outreach teams at hospital level and patient level, and to establish which component of the TTS has the greatest effect on outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Limitationsmentioning

confidence: 88%

Section: Standardised Handover Toolmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

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Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Hogan

Hutchings

Wulff

et al. 2019

Health Serv Deliv Res

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show abstract

“…18 Electronic sign-out applications are tools used as standalone or integrated with the electronic medical record to ensure a structured transfer of patient information during healthcare provider handoffs. Two systematic reviews 19 , 20 evaluating outcomes of electronic tools supporting physician shift-to-shift handoffs concluded that most studies supported using an electronic tool with an improvement in the process of handover, fewer omissions of critical patient information and reduced handover time when using the electronic tool with few low-quality studies assessing patient outcome measures. The authors in both reviews also noted that a significant number of the included studies were not well designed and further evaluation using rigorous study designs is needed.…”

Section: Electronic Sign-out and Hand-off Toolsmentioning

confidence: 99%

The impact of health information technology on patient safety

Alotaibi

Federico

2017

SMJ

279

150

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Since the original Institute of Medicine (IOM) report was published there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety. This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. We conclude that health information technology improves patient’s safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. Healthcare organizations need to be selective in which technology to invest in, as literature shows that some technologies have limited evidence in improving patient safety outcomes.

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“…We obtained all of the articles included in systematic reviews of the handoffs literature published from 2013 to March 2016. Of the articles reviewed (198), only 34.7% (Abraham et al, 2014;Davis et al, 2015;Flemming & Hubner, 2013;T. Mardis et al, 2016;Masterson, Gill, Turner, Shrichand, & Giuliani, 2013;Moller et al, 2013;Pucher et al, 2015;Robertson, Morgan, Bird, Catchpole, & McCulloch, 2014;Sherman, Sand-Jecklin, & Johnson, 2013) reported any funding (Table 2).…”

Section: The Badmentioning

confidence: 99%

Handoff Research

Riesenberg

Davis

O’Hagan

2016

Proceedings of the International Symposium on Human Factors and

Self Cite

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Handoffs, or the transfer of patient care from one provider to another, are a complex task which can both contribute to and prevent medical errors. In this article, we review three topics that illustrate what is good, bad, and ugly about the current state of handoff research. First, we examine the good, the increase both in quantity and variety of research into patient handoffs over the past 30 years. Second, we discuss what is lacking, funding for handoff research. Finally we review one of the most troubling aspects of handoffs, the general lack of education and training for medical students, residents, and nursing students, to prepare them to manage handoffs as health care providers.

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Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Cited by 33 publications

References 49 publications

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

The impact of health information technology on patient safety

Handoff Research

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