Fellow Michigan State University College of Human Medicine Lansing, Michigan, United States
Background: An effective and safe handoff tool is one of the most important aspects of patient care and is often overlooked. The wide range of acuity and complexity in the NICU requires a system incorporating human, machine, environmental, and cultural factors. Also, the various levels of experience and training of providers working in the NICU necessitate an easily adaptable handoff that is precise and time efficient. A provider has to be cognizant and include relevant medical and social components of care when handing off patient care, leading to improved patient care, and minimize errors. Objective: Our project was to create a systematic but precise handoff to improve patient care while minimizing medical errors by altering several contributing factors. Design/Methods: Our pre-QI handoff was a census sheet used by the nursing team with added verbal details, the efficiency of which depended on the individual provider's level of experience and attention to detail. A medical provider survey and observation of evening and morning handoffs were utilized to examine and evaluate the current process of patient handoff. Various contributing factors including human (willingness to accept change, survey participation, time and space for handoff), machine (build an EMR generated handoff tool), environmental (minimize interruptions using specific space and time) and cultural factors (all team members understanding the importance of new system) were anticipated to create change. Our QI team implemented interventions targeting all factors. An EHR-based handoff tool developed and implemented with the help of an information technology analyst (ITA). Protected time, space needs were detailed along with education to all providers. Key driver, and fishbone diagrams were created. The same provider surveys and morning and evening handoff observations will be used for PDSA cycles every month to evaluate improvement. The QI project began July 2023 and will be ongoing until March 2023.
