Kristina DeVore MSN, RN (is Nurse Navigator, Department of Nursing–Continuum of Care Management, University of Iowa Health Care.), Katherine Schneider MSN, RN (is Clinical Coordinator, Department of Emergency Medicine, Carver College of Medicine, University of Iowa.), Elyse Laures PhD, RN (is Nurse Scientist, Department of Nursing–Nursing Research and Evidence-Based Practice, University of Iowa Health Care.), Alison Harmon MSN, RN (is Director of Emergency Medical Transport Services, Department of Nursing, University of Iowa Health Care.), Paul Van Heukelom MD (is Associate Clinical Professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa. Please address correspondence to Katherine Schneider)
{"title":"改善从门诊医疗机构送往急诊科的患者的治疗效果：接收者驱动的移交流程改进","authors":"Kristina DeVore MSN, RN (is Nurse Navigator, Department of Nursing–Continuum of Care Management, University of Iowa Health Care.), Katherine Schneider MSN, RN (is Clinical Coordinator, Department of Emergency Medicine, Carver College of Medicine, University of Iowa.), Elyse Laures PhD, RN (is Nurse Scientist, Department of Nursing–Nursing Research and Evidence-Based Practice, University of Iowa Health Care.), Alison Harmon MSN, RN (is Director of Emergency Medical Transport Services, Department of Nursing, University of Iowa Health Care.), Paul Van Heukelom MD (is Associate Clinical Professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa. Please address correspondence to Katherine Schneider)","doi":"10.1016/j.jcjq.2024.01.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS).</p></div><div><h3>Methods</h3><p>The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS.</p></div><div><h3>Results</h3><p>The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 preintervention to 2.04 postintervention (<em>p</em> = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, <em>p</em> = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (<em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver-Driven Handoff Process Improvement\",\"authors\":\"Kristina DeVore MSN, RN (is Nurse Navigator, Department of Nursing–Continuum of Care Management, University of Iowa Health Care.), Katherine Schneider MSN, RN (is Clinical Coordinator, Department of Emergency Medicine, Carver College of Medicine, University of Iowa.), Elyse Laures PhD, RN (is Nurse Scientist, Department of Nursing–Nursing Research and Evidence-Based Practice, University of Iowa Health Care.), Alison Harmon MSN, RN (is Director of Emergency Medical Transport Services, Department of Nursing, University of Iowa Health Care.), Paul Van Heukelom MD (is Associate Clinical Professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa. Please address correspondence to Katherine Schneider)\",\"doi\":\"10.1016/j.jcjq.2024.01.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS).</p></div><div><h3>Methods</h3><p>The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS.</p></div><div><h3>Results</h3><p>The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 preintervention to 2.04 postintervention (<em>p</em> = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, <em>p</em> = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (<em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.</p></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-01-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553725024000370\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024000370","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver-Driven Handoff Process Improvement
Background
Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS).
Methods
The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS.
Results
The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 preintervention to 2.04 postintervention (p = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, p = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (p < 0.001).
Conclusion
Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.
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