Improved Physician Work Flow After Integrating Sign-out Notes into the Electronic Medical Record

Bernstein, Jonathan A.; Imler, Daniel; Sharek, Paul J.; Longhurst, Chris

doi:10.1016/s1553-7250(10)36013-2

Cited by 41 publications

(35 citation statements)

References 8 publications

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“…Most studies that provided self-reported data on time devoted to activities related to handoffs showed reductions in time allocated to handoffs. 23,27,31,34,39,42 In contrast, in 1 study respondents self-reported a decrease in time devoted to handoff preparation and an increase in the amount of time needed to update handoff information. 32 Another study found conflicting results, with 37% of respondents reporting the electronic system was faster, and 57% reporting the card-based system (control) was faster to use.…”

Section: Self-reported Measuresmentioning

confidence: 76%

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

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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Background Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. Objective This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. Methods We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. Results Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. Conclusions The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.

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Section: Self-reported Measuresmentioning

confidence: 76%

“…[22][23][24][25][26][27]31,32 However, in 1 of these studies, 22.6% of respondents reported there was information they did not receive at handoff that would have helped them care for patients. 26 Other studies 22,25,30,33,36,37 noted that respondents reported increased quality of handoffs with an electronic handoff system.…”

Section: Self-reported Measuresmentioning

confidence: 99%

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

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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“…2 An increased focus on effective handoffs occurred in 2003 when the Accreditation Council for Graduate Medical Education restricted resident work hours, resulting in more physician-to-physician handoffs and thus increased handoff-related risk in academic medical centers. [3][4][5] Additional focus occurred in 2006, when The Joint Commission required accredited institutions to implement a standardized handoff approach emphasizing reciprocal communication. 6 In 2007, the World Health Organization and The Joint Commission highlighted the role of standardized processes to reduce handoff-related errors.…”

mentioning

confidence: 99%

Decreasing Handoff-Related Care Failures in Children’s Hospitals

Bigham¹,

Logsdon

Manicone³

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures.METHODS: Twenty-three children' s hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS:Twenty-three children' s hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P , .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P , .05]; clear transition of responsibility from 92% to 96% [P , .05]; and minimized interruptions and distractions from 84% to 90% [P , .05]) as did overall satisfaction with the handoff (from 55% to 70% [P , .05]).CONCLUSIONS: Implementation of a standardized evidence-based handoff process across 23 children' s hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction. Pediatrics 2014;134: e572-e579 AUTHORS:

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“…The EMR implementation at SCH was a transition from one commercially available EMR system to another. The legacy system included computerized physician order entry (CPOE) and online clinical documentation in the inpatient setting with partial adoption of online clinical documentation and no CPOE in the outpatient setting [16][17][18][19]. The newly procured software system was already in place at the physically adjacent but financially and operationally independent adult hospital Stanford Health Care for over five years at the time of implementation [20].…”

Section: Case Reportmentioning

confidence: 99%

Successful Physician Training Program for Large Scale EMR Implementation

Stevens¹,

Mailes²,

Goad³

et al. 2015

Appl Clin Inform

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SummaryEnd-user training is an essential element of electronic medical record (EMR) implementation and frequently suffers from minimal institutional investment. In addition, discussion of successful EMR training programs for physicians is limited in the literature. The authors describe a successful physician-training program at Stanford Children's Health as part of a large scale EMR implementation. Evaluations of classroom training, obtained at the conclusion of each class, revealed high physician satisfaction with the program. Free-text comments from learners focused on duration and timing of training, the learning environment, quality of the instructors, and specificity of training to their role or department. Based upon participant feedback and institutional experience, best practice recommendations, including physician engagement, curricular design, and assessment of proficiency and recognition, are suggested for future provider EMR training programs. The authors strongly recommend the creation of coursework to group providers by common workflow. BackgroundDeliberate and comprehensive end-user training is essential for the implementation, actualization, and end-user satisfaction with an organization's chosen electronic medical record (EMR) [1][2][3][4][5][6][7]. Given the variety of roles and specialized workflows performed by medical staff, physicians comprise a unique group of end-users for whom distinct recommendations are essential. However, there are few guidelines in the literature addressing the development and implementation of an EMR training program for physicians. Rockswold et al, found that 43% of clinician users rated initial training as "less than adequate, " 94.6% of respondents thought their ability to use the EMR could be improved, and the authors called for the closer study of both training content and delivery [8]. A review of the literature reveals general training strategies for all employees [9], recommendations for nursing populations [10], post-implementation training [11], training within the broader context of a successful EMR implementation [3,6,12,13], and training as a barrier to EMR adoption [14,15]. To our knowledge, this is the first manuscript to describe the focused development and implementation of a successful physician training program in preparation for a large scale EMR implementation. Case ReportThis case report outlines a training program developed at Stanford Children's Health (SCH). SCH includes Lucile Packard Children's Hospital (LPCH), the major teaching hospital for pediatric and obstetric care for Stanford University, as well as about 100 network physicians in a medical foundation. As of 2014, LPCH has 311 beds, approximately 1,250 faculty and advanced practice providers (APPs), and approximately 1,000 rotating fellows and residents. The EMR implementation at SCH was a transition from one commercially available EMR system to another. The legacy system included computerized physician order entry (CPOE) and online clinical documentation in the inpatient setting w...

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Improved Physician Work Flow After Integrating Sign-out Notes into the Electronic Medical Record

Cited by 41 publications

References 8 publications

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

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

Decreasing Handoff-Related Care Failures in Children’s Hospitals

Successful Physician Training Program for Large Scale EMR Implementation

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