Five teams of residents at TIRR Memorial Hermann and the Baylor/UTHealth Alliance for Physical Medicine and Rehabilitation are engaged in quality improvement projects that will benefit patients by streamlining processes for greater efficiency and improving the quality of care. Among them is an ongoing project focused on improving resident sign-out and patient handoff using a secure online system, begun three years ago under the leadership of former resident Rachel Zeider, MD.
“Handoff among healthcare providers has been recognized as a major source of medical errors,” says Sunny Dhah, DO, a fourth-year resident who leads the project in collaboration with Marie Frando, MD. “Last year we addressed issues involved in creating a standardized handoff system that meets Joint Commission requirements for passing patient-specific information from one caregiver to another to ensure continuity and safety of patient care. The problem of safe and efficient transfer of care has increased over the years as new and complex diagnostic tools and more complex treatment options have become available. Traditionally, residents ensured continuity of care by working long hours and minimizing transfers, but the 80-hour workweek has curtailed that practice.”
Most prior research related to handoff has focused on the communication aspects, with limited emphasis on the overall process, especially from the clinician workflow perspective. Working together, Dr. Dhah, Dr. Frando, Dr. Zeider, Benjamin Mega, MD, and Ekta Gupta, MD, created an online sign-out tool that would provide a secure, low-cost handoff system to improve patient care with a focus on workflow within a two-hospital, multiple-service rehabilitation call pool.
“At TIRR Memorial Hermann and Memorial Hermann-Texas Medical Center, we found the major limitations were related to accessibility, efficiency, compliance, incomplete information, security, HIPAA compliance and physician satisfaction,” Dr. Dhah says. “We started with a series of surveys to address goals that residents and attending physicians considered important.”
Residents and attending physicians at the two hospitals were asked to complete a 25-question survey. Based on the results, the system was implemented for a six-week period during January and February 2013. Users of the system completed post-implementation surveys, which were analyzed by the team of residents.
“The resident survey results showed improved perception of security, efficiency and physician satisfaction after implementation of the system,” Dr. Dhah says. “The attending physician survey results were mixed, with improved physician satisfaction but continued concerns about efficiency, patient safety and security.”
Next steps focused on gaining greater buy-in to the project among attending physicians with the help of Victor H. Chang, MD, clinical director of the Brain Injury and Stroke Program at TIRR Memorial Hermann, who serves as patient safety officer. The residents also adapted the survey to allow attending physicians and residents to participate in the design of the sign-out process. The results of the project will be presented later this spring at TIRR Memorial Hermann’s annual residents’ research symposium.
“When I first started working on this project, I wasn’t 100 percent convinced of its usefulness,” Dr. Dhah says. “But I’ve seen that it’s particularly important in our training as residents because we rotate at eight different institutions, which requires a strong handoff process. I’ve also learned the fundamentals of writing a research project while keeping an eye on the big picture and the end goal. It’s given me insight into the leadership skills you need to motivate people and involve them in what you’re trying to achieve.”