Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit

Abstract

Objective:

Patient care handoffs represent an important transfer of information.^{1, 2, 3, 4} Stand-alone electronic sign-out systems (such as Microsoft Word documents and Microsoft Access databases) require significant manual data transcription, which is a potential source of error.² Sign-out systems integrated within a hospital's electronic medical record (EMR) have the ability to automate the retrieval of patient information from the EMR, and have been shown to facilitate handoffs.^{2, 5, 6, 7} To date, the customization of a commercial EMR for neonatal intensive care unit-specific handoffs has not been documented. The objective of this study was to evaluate the effect of integration of a stand-alone electronic handoff tool into the EMR on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit.

Study Design:

A prospective survey was conducted on neonatal care providers in an academic children's hospital 1 month before (n=52) and 6 months after (n=46) integration of a stand-alone Microsoft Access neonatal handoff tool into the EMR. Medical, nursing and ancillary staff usage of the EMR-integrated neonatal sign-out report was tracked systematically by the EMR itself.

Result:

Providers reported that sign-out information was somewhat or very accurate at a rate of 78% with the stand-alone handoff tool and at 91% with the EMR-integrated tool (P<0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration of neonatal sign-out, 92% of providers were satisfied with the process of updating sign-out information (P<0.01) and 98% were satisfied with the printed sign-out document (P<0.01). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P<0.01). Following EMR integration, ∼25% of neonatal sign-out usage was by nursing staff and over 10% of usage was by ancillary staff.

Conclusion:

Integration of a neonatal intensive care unit-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and workflow. EMR integration of the handoff tool also resulted in increased access to and communication of sign-out information to nursing and ancillary staff. Customization of commercially available EMRs to meet the unique demands of the neonatal intensive care unit is possible; we showed specifically the potential to improve handoff communication, an important aspect of patient safety.