A Staff-Driven Process Improvement Project: Small Changes Can Streamline the Handoff Process

Purpose for the program:

There were inconsistencies in the Labor and Birth to Maternity Patient Handoffs that contributed to dissatisfaction between units and to potential patient care errors.  A review of the literature related to best practice for perinatal handoffs was presented to the Women’s Services staff nurse cluster. 

Proposed change:

The SBAR transfer template was revised to reflect a complete, yet succinct comprehensive overview of the patient’s plan of care.  Specifics were included regarding screens of the medical record to be reviewed within a given time frame.  While all staff members are teamSTEPPS trained, barriers to the safe and seamless handoff were identified.  Those barriers fell into one of our ‘3 Cs’ bucket:  collaboration, consistency and communication.  Audits were then designed to identify the degree to which those inconsistencies existed.  Input was then solicited from both units for ways to improve the handoff transfers. The goals were to improve communication and teamwork among staff, to improve patient satisfaction and to support our responsibility to Service Excellence.

Implementation, outcomes and evaluation:

The process improvement project was carried out over a period of 10 months with a total of 235 audit tools collected over three audit cycles.  Staff members were educated about the key points identified by the Cluster following the initial audit cycle. The second audit cycle represented the process improvements following the implementation of the handoff strategies and the final audit cycle confirmed that these strategies were hardwired.  These strategies included:  utilizing the SBAR transfer tool; contact numbers for both the transferring and the receiving nurse located in the patient’s medical record; timeliness of the initial and secondary call from the transferring nurse to the receiving nurse; involvement of the business associate in the transfer process; room readiness; direct handoff in the patient’s room; verification of the patient’s identification; specific screens reviewed during handoff and verification of IV fluids and site. 

Implications for nursing practice:

Although all of the strategies were simplistic and revolved around communication and consistency, there was a marked improvement in the timeliness and direct communication between staff, thus contributing to a greater degree of satisfaction between units.  This project exemplified that process improvement projects do not have to be complex to directly impact patient safety and staff satisfaction.  This service line shared governance cluster worked as a team to overcome challenges faced at handoff with measurable improvements.

Keywords:

Handoffs, Communication, SBAR Transfer Tool, Staff satisfaction