Bassett Medical Center, Cooperstown, NY
A Standardized EHR Handoff Tool for Medicine and Surgery

Abstract

Background: Bassett Medical Center did not have a standardized tool for handoffs in the hospital setting, and administrative and GME leadership were seeking such an instrument. Prior to full deployment of Epic EHR in December 2013, medicine and surgery residents used Word-based handoff tools that were not part of the EHR, not HIPAA compliant, and augmented by a verbal handoff. Our goal was to create a standardized tool for handoffs in the medicine and surgery resident hospital teams.

Methods: In fall 2013, we assembled a steering committee composed of senior administrative leadership in quality improvement/safety, information technology, and medical education to support the development of standardized handoff tools. Workgroups in the residencies created and modified handoff tools using PDSA techniques. Monthly or bimonthly meetings of the steering committee with the residents and program directors provided incentive and administrative support. The medicine residency workgroup created a pre/post implementation survey to assess the value of the handoff tool.

Results: An audit of medical inpatient medical records showed 100% adherence by the medicine residents in the use of the EHR for handoff. Strict adherence to the method prescribed in the program was 65%. This lower rate was likely due to the technical need of moving information from one area of the EHR to another. The percentage of residents who felt that the written handoff was an effective communication device increased from 58% pre-EHR handoff tool to 83% post.

Conclusions: The development of an EHR-based handoff tool at Bassett Medical Center was a successful project that demonstrates the importance of goal alignment and teamwork. Surveys revealed that residents considered handoffs to be more thorough, more accurate, and better organized after implementation of the handoff tool. In addition, the culture is more attuned to transitions of care, and the faculty is beginning to understand that they need to assess resident competency in this area.