Date of Award
Evidence-Based Project Report
Doctor of Nursing Practice (DNP)
Theresa A. Kessler
Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the ICU. Rogers’ Diffusion of Innovation Theory was used as the theoretical framework. The Stetler Model guided this project at a non-profit, 205-bed hospital, in the Midwest. The intervention included the development of a standardized handoff that (a) utilized a specific handoff tool, (b) minimized interruptions and multitasking, (c) enabled nurses to ask questions when information was unclear, (d) included anticipatory changes in patient’s condition, (e) ensured timing of the patient transfer was appropriate, (f) and confirmed ancillary staff was notified and available. Data for demographics of ED and ICU nurses, pre- and post-implementation questionnaires, and patient transfer times from ED to ICU were collected. Descriptive analysis was used to investigate nursing demographics regarding age, gender, race, and education. Two identical questions were asked of the nurses in the pre-and post-implementation questionnaires. Paired t-tests analyzed the nurses’ responses and found significant improvements in nursing communication (t=7.23, df=46, p<=0.00) and patient safety (t=5.76, df=46, p<=0.00). An independent t-test analyzed the patient transfer times from the ED to ICU. Patient transfer time decreased significantly pre (M=82.85 minutes; SD = 18.24) to post (M=75.47 minutes; SD = 17.74) intervention (t=1.974, df=283, p=0.0049). The patient transfer time from ED to ICU decreased by more than seven minutes. The p value indicates strong evidence against the null hypothesis. The clinical site adopted aspects of this standardized handoff for implementation not only in transfer of care from the ED to the ICU, but for handoffs throughout the hospital.
Abbring, Melinda, "Implementation of a Standardized Handoff During Transition of Care from the Emergency Department to the Intensive Care Unit" (2017). Evidence-Based Practice Project Reports. 104.