Academic literature on the topic 'Handoff impact evaluation'
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Journal articles on the topic "Handoff impact evaluation"
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Mokhtari, A., D. Simonyan, A. Pineault, M. Mallet, S. Blais, and S. Berthelot. "MP38: The impact of physician handoffs on the outcomes of emergency department patients: a medical administrative database retrospective cohort study." CJEM 22, S1 (May 2020): S56. http://dx.doi.org/10.1017/cem.2020.186.
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Introduction: A physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes. Methods: We included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Québec-Université Laval during fiscal year 2016-17. Data were extracted from the local hospital discharge database and the ED information system. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted multilevel multivariate regression analyses, accounting for patient and hospital clusters and adjusting for demographics, CTAS score, comorbidities, admitting department delay before evaluation by an emergency physician and by another specialty, emergency department crowding, initial ED orientation and handoff timing. We conducted sensitivity analyses excluding patients that had an ED length of stay > 24 hours or events that happened after 72 hours of hospitalization. Results: 21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson index score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In multilevel multivariate analysis (OR handoff/no handoff [CI95%] or GMR[SE]), handoff status was not associated with mortality 0.89[0.77,1.02], surgery 0.95[0.85,1.07] or hospital length of stay (-0.02[0.03]). Non-handed-off patients had an increased risk of ICU admission (0.75[0.64,0.87]). ED occupancy rate was an independent predictor of mortality and ICU admission rate irrespectively of handoff status. Sensitivity and sub-group based analyses yielded no further information. Conclusion: Emergency physicians’ handoffs do not seem to increase the risk of severe in-hospital adverse events. ED occupancy rate is an independent predictor of mortality. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity.
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Banala, Srinivas, Carmen E. Gonzalez, Norman Brito-Dellan, David Rubio, Mohamed Ait Aiss, Terry Rice, Karen Chen, Diane C. Bodurka, and Carmelita P. Escalante. "Safer transitions of care at a major cancer center: The emergency center to hospitalist experience." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 247. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.247.
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247 Background: Failures in communication lead to serious medical errors particularly during transitions of care. A standardized handoff of patients requiring admission to the inpatient setting between the Emergency Center (EC) and the Hospitalist Inpatient Service (HIS) at a comprehensive cancer center was lacking during this vulnerable time. Methods: A quality pilot study using Plan, Do, Study, Act methodology was conducted. First, root cause analysis and process mapping of the current state was performed to identify pitfalls of the handoff process between the EC and the Hospitalist Service. Second, a validated standardized handoff tool, “I-PASS” (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, and Synthesis by receiver) was selected and then transformed to DE-PASS, where D stands for Decisive problem requiring admission and E for Evaluation, to suit the EC workflow. The DE-PASS identified patients at higher risk for complications as urgent and emergent in the evaluation section and required a verbal communication in addition to an email using DE-PASS format. Third, we measured pre versus post intervention impact metrics. ICU transfers and Rescue Team calls within 24 hours were obtained from 822 patients. Time interval between EC admission physician order and HIS order was analyzed in a population of 174 randomly selected patients. Provider satisfaction with handoffs was surveyed. Results: The DE-PASS utilization ranged from 75% to 100% by the end of the pilot. The data analysis revealed a 60% reduction in the number of ICU transfers and a 64% reduction of Rescue Team calls post intervention. There was an 18% reduction in the interval time for an inpatient order in the medical record. EC Physicians satisfaction with DE-PASS increased by 10% and the Hospitalists increased by 40%. Conclusions: Implementation of the standardized handoff tool DE-PASS led to improved communication between two clinical services of a major cancer center. Patients’ safety improved by designation of risk stratification and reducing the time to evaluate unstable patients by the receiving HIS. Physician’s satisfaction with the handoff process increased.
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Abraham, Joanna, Alicia Meng, Sanjna Tripathy, Michael S. Avidan, and Thomas Kannampallil. "Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs." BMJ Quality & Safety 30, no. 6 (February 9, 2021): 513–24. http://dx.doi.org/10.1136/bmjqs-2020-012474.
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ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.
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Hollins, Lori-Linell, Marilena Wolf, Brian Mercer, and Kavita Shah Arora. "Feasibility of an ethics and professionalism curriculum for faculty in obstetrics and gynecology: a pilot study." Journal of Medical Ethics 45, no. 12 (August 14, 2019): 806–10. http://dx.doi.org/10.1136/medethics-2018-105189.
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ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty.
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Islam, Shayla, Aisha Hassan A. Hashim, Mohamed Hadi Habaebi, Azween Abdullah, and Mohammad Kamrul Hasan. "A Numerical Evaluation on Multi-Interfaced Fast Handoff Scheme: Impact of Rising Link Switching Delay for a High Speed Car." Advanced Science Letters 22, no. 10 (October 1, 2016): 2804–8. http://dx.doi.org/10.1166/asl.2016.7107.
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Steadman, Randolph H., Amanda R. Burden, Yue Ming Huang, David M. Gaba, and Jeffrey B. Cooper. "Practice Improvements Based on Participation in Simulation for the Maintenance of Certification in Anesthesiology Program." Anesthesiology 122, no. 5 (May 1, 2015): 1154–69. http://dx.doi.org/10.1097/aln.0000000000000613.
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Abstract Background: This study describes anesthesiologists’ practice improvements undertaken during the first 3 yr of simulation activities for the Maintenance of Certification in Anesthesiology Program. Methods: A stratified sampling of 3 yr (2010–2012) of participants’ practice improvement plans was coded, categorized, and analyzed. Results: Using the sampling scheme, 634 of 1,275 participants in Maintenance of Certification in Anesthesiology Program simulation courses were evaluated from the following practice settings: 41% (262) academic, 54% (339) community, and 5% (33) military/other. A total of 1,982 plans were analyzed for completion, target audience, and topic. On follow-up, 79% (1,558) were fully completed, 16% (310) were partially completed, and 6% (114) were not completed within the 90-day reporting period. Plans targeted the reporting individual (89% of plans) and others (78% of plans): anesthesia providers (50%), non-anesthesia physicians (16%), and non-anesthesia non-physician providers (26%). From the plans, 2,453 improvements were categorized as work environment or systems changes (33% of improvements), teamwork skills (30%), personal knowledge (29%), handoff (4%), procedural skills (3%), or patient communication (1%). The median word count was 63 (interquartile range, 30 to 126) for each participant’s combined plans and 147 (interquartile range, 52 to 257) for improvement follow-up reports. Conclusions: After making a commitment to change, 94% of anesthesiologists participating in a Maintenance of Certification in Anesthesiology Program simulation course successfully implemented some or all of their planned practice improvements. This compares favorably to rates in other studies. Simulation experiences stimulate active learning and motivate personal and collaborative practice improvement changes. Further evaluation will assess the impact of the improvements and further refine the program.
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Parikh, Anish B., Elizabeth Aronson, Amir S. Steinberg, and Cardinale B. Smith. "Standardization of the inpatient oncology signout process." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 253. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.253.
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253 Background: Provider handoffs are prone to medical errors which in turn impact patient outcomes. Standardized signout tools have helped address this issue, however not in oncology. Methods: A pre-intervention survey (S1) was used to evaluate the current inpatient signout process and identify flaws by querying inpatient hematology/oncology fellows, attendings, nurse practitioners, and physician assistants. This data informed the development of a standardized electronic signout tool which was subsequently piloted on our bone marrow transplant unit. A post-intervention survey (S2) is currently evaluating the impact of this tool. Results: Of S1 respondents (54%, 71/131), 75% felt the signout process needs improvement, largely due to outdated (70%) or incomplete (24%) information and general disorganization (49%). Nearly half felt the signout contains too much (28%) or too little (18%) information. 18% felt that patient care had been compromised or delayed due to poor signout. Items requested for inclusion in the signout tool by more than half of respondents included patient identifiers, health care proxy, code status/goals of care, active issues summary, cancer details and treatment history, and a to-do list. Full S1 results are shown in Table; S2 results are pending. Conclusions: Use of a standardized, electronic signout tool can further enhance the inpatient handoff process in terms of safety and efficiency. [Table: see text]
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Petrovic, Michelle A., Hanan Aboumatar, Adam T. Scholl, Randeep S. Gill, Dina A. Krenzischek, Melissa S. Camp, Carolyn M. Senger, et al. "The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units." Journal of Clinical Anesthesia 27, no. 2 (March 2015): 111–19. http://dx.doi.org/10.1016/j.jclinane.2014.09.007.
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Lane, Christine, Kathleen Doherty, and Mark Poteet. "606 Establishing a Deep Sedation Program: Challenges and Successes from a Nursing Management Perspective." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S146. http://dx.doi.org/10.1093/jbcr/iraa024.232.
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Abstract Introduction A burn center with a high volume of burn admissions was looking for ways to decrease the pain and anxiety experienced by patients during wound care. Patients requiring surgical dressing removal or demonstrating difficulty in coping during wound care were of particular concern. Discussions between anesthesia providers and the burn team led to the concept of anesthesia safely providing deep sedation in the inpatient wound care center for select dressing changes. Nursing management began to work through the challenges of implementing the Burn Center Deep Sedation Program. Methods Processes for identifying, scheduling, and recovering patients were established. All Burn Acute Care Unit (BACU) patients requiring a surgical dressing removal or demonstrating poor coping during wound care would qualify for deep sedation. Nursing management worked to create an online scheduling system, and designated a room which was set up with anesthesia equipment and supplies. Candidates were reviewed for deep sedation and a schedule created for the following day. All patients required a Burn Intensive Care Unit (BICU) nurse during the recovery period. A BICU room adjacent to the wound care center became the deep sedation recovery room, and was staffed by the BICU charge nurse. BICU nurses received additional training in post anesthesia care prior to the program implementation. Once all educational needs and logistical changes were addressed, the deep sedation program began operating seven days per week. Results Starting in January 2016 deep sedation has been provided to approximately 400 cases per year. No additional staff was required, only shifting responsibilities of existing nursing personnel. Designating a specific room for deep sedation has ensured that anesthesia providers have access to the appropriate equipment and has minimized disruptions to the flow of other dressing changes occurring throughout the day. The impact of the program on pain and anxiety is currently under evaluation. Informal feedback from patients and staff members has been very positive. Conclusions The challenge in developing this program was the amount of education and planning required prior to implementation. Once the program was active, the challenges that occurred involved the scheduling system. An additional benefit of the program was the teamwork required between BICU and BACU nurses to safely handoff patients. The deep sedation program has also strengthened the burn team’s relationship with the anesthesia providers, whose commitment to the project was appreciated by all involved. A team approach and a collective mission to improve care for burn patients have driven this project to its current success. Applicability of Research to Practice The collaboration between the burn team and anesthesia has resulted in an improved wound care experience for the patient.
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Giugale, Lauren E., Sarah Sears, Erin S. Lavelle, Charelle M. Carter-Brooks, Michael Bonidie, and Jonathan P. Shepherd. "Evaluating the Impact of Intraoperative Surgical Team Handoffs on Patient Outcomes." Female Pelvic Medicine & Reconstructive Surgery 23, no. 5 (2017): 288–92. http://dx.doi.org/10.1097/spv.0000000000000370.
Full textDissertations / Theses on the topic "Handoff impact evaluation"
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Banh, Mai Thi Quynh, and n/a. "Quantification, characterisation and impact evaluation of mobile IPv6 hand off times." Swinburne University of Technology, 2005. http://adt.lib.swin.edu.au./public/adt-VSWT20070608.094836.
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There is a growing range of IP-based data and voice applications using mobile devices (e.g. 3rd ,
4th generation mobile phones and PDAs) and new access technologies (e.g. Bluetooth, 802.11,
GPRS, ADSL). This growth is driving a desire to support mobility at the IP level � in other
words, allowing an IP host to keep on communicating with other hosts while roaming between
different IP subnetworks.
Mobile IPv6 allows hosts to move their physical and topological attachment points around
an IPv6 network while retaining connectivity through a single, well-known Home Address.
Although Mobile IPv6 has been the subject of simulation studies, the real-world dynamic
behavior of Mobile IPv6 is only gradually being experimentally characterised and analysed.
This thesis reviews the use of Mobile IPv6 to support mobility between independent
802.11b-attached IPv6 subnets, and experimentally measures and critically evaluates how long
an end to end IP path is disrupted when a Mobile IPv6 node shifts from one subnetwork to
another (handoff time). The thesis describes the development of an experimental testbed
suitable for gathering real-world Mobile IPv6 handoff data using publicly available, standards compliant
implementations of Mobile IPv6. (An open-source Mobile IPv6 stack (the KAME
release under FreeBSD) was deployed).
The component of handoff time due to 802.11b link layer handoff is measured separately to
assess its impact on the overall Mobile IPv6 handoff time. Using Mobile IPv6 handoff results,
the likely performance impact of Mobile IPv6 handoff on a common webcam application and a
bulk TCP data transfer is also evaluated. The impact of handoff on these applications clearly
shows that a default Mobile IPv6 environment would be highly disruptive to real-time and
interactive applications during handoff events, even if the underlying link-layer handoff was
instantaneous.