Technology Project Proposal

INTRODUCTION: Effective communication during the handoff between healthcare teams is critical to nurturing continuity and safe patient care. Studies have shown that communication breakdown between healthcare professionals is a significant challenge causing errors during the handovers and is primarily caused by land standardization.

OBJECTIVES: a) overall objective is to implement an EHR-based Standardized Handoff Report to enhance communication between anesthesia providers and PACU team; b) implement an EHR-based, e-handoff tool to reduce errors; c) integrate SBAR protocol; and d) initiate staff training on the program.

METHOD: The project will adopt a pretest-posttest design where similar assessment measures are provided to healthcare providers being surveyed before and after they have been exposed to the technology and measures used to assess the program’s efficacy.

CONCLUSION: Lack of standardized handoff procedures leads to poor communication between anesthesia providers and the PACU team, causing medical errors and jeopardizing patient safety and continuity of care. This proposed project aims to implement an EHR-based Standardized Handoff Report to enhance communication between anesthesia providers and the PACU team.

Technology Project Proposal: Implementation of a Standardized Electronic Anesthesia Handoff Report between the Anesthesia Provider and Post-Anesthesia Care Unit (PACU) Nurse

Introduction

Background and Significance of the Study

Effective communication during the handoff between healthcare teams is critical to nurturing continuity and safe patient care. This project proposal explores the implementation of standardized electronic anesthesia handoff reports between the anesthesia provider and post-anesthesia care unit (PACU) nurse. According to the American Association of Nurse Anesthetists (AANA), nurses must make available handover, accurately report the patients’ conditions, including critical information, and transfer the care responsibility to another qualified healthcare provider to ensure patient safety and continuity of care (Wilbanks et al. 2018). However, notwithstanding the AANA standard of practice, studies have shown that communication breakdown between the health care professional is a significant challenge causing errors during the handovers, and the procedure is no longer perceived as a “care-neutral event.” Handover in the health care practice is when most breakdowns in communication can occur, and vital information may be lost, leading to inefficiencies, delays, adverse events, increased costs and length of stay, and patient harm. Breakdown in communication causes about 91% of the anesthesia-related sentinel and 80% of healthcare sentinel events, jeopardizing patient safety and continuity of care (Abir & Mhyre, 2017). The anesthesia nurses adopt a team approach and allow multiple anesthesia providers, anesthesiologists, student registered nurse anesthetists (SRNAs), and certified registered nurse anesthetists (CRNAs) to participate in a single patient’s surgery (Wilbanks et al. 2018).

As a result, multiple handovers between anesthesia providers themselves and with PACU nurses resulted in complications. Lack of standardization of the handover is cited as the primary cause for communication breakdown during patient handover. Therefore, implementing standardized electronic anesthesia handoff reports between the anesthesia teams and post-anesthesia care unit (PACU) nurses can reduce communication breakdown and loss of vital information, ensuring the quality of care and patient safety (Wang, He, & Feng, 2021).  Lindsay and Rue (2017) write that variations and related consequences during handovers are minimized by the standardization of information (Lindsay & Rue, 2017). Fully-deployed EHR and communication frameworks, SBAR protocol, is adopted to improve to ensure that adequate patient-centered information is communicated to enhance continuity of care and patient safety. 

Review of Literature Evidence

A comprehensive review of existing literature on the standardization of handoff reports and electronic health records (EHR) will guide most of this study. The academic search engines used for the analysis include PubMed and CINAHL. Keywords used include handoff, anesthesia, electronic health records, electronic medical records, quality, patient safety, Post-Anesthesia Care Unit, and sign-outs.

Handoff Report Standardization

Until lately, the safety during anesthesia handoffs had not been extensively documented. The literature examination of surgical malpractice complaints shows that the highest portion of preoperative errors, including over 43% of communication breakdowns, happens postoperatively because of poor handoffs. Research shows that poor handoffs between healthcare providers pose a great danger to the patients’ safety (Randmaa et al., 2017). Most recent studies have established a positive correlation between anesthesia handoff reports, continuity and quality of care, and patient safety. Anesthesia care transitions have been associated with increased risks of morbidity and mortality, up to 8%. In cardiac surgeries, anesthesia handovers have been shown to lead to 43% higher chances of mortality and up to about 27% higher risks of severe complications (Randmaa et al., 2017). Such findings challenge the long-held supposition that anesthesia nursing handoff is a neutral care procedure. Effective communication is an integral element needed in the surgical setting to ensure patient safety and continuity of care. Reine and Karina (2021) noted that healthcare providers receive and convey patient-related information during patient handover, and such information forms the cornerstone of communication within healthcare systems. The researchers maintained that effective communication must be specific, straightforward, and concise to promote patient safety and prevent harm (Reine & Karina 2021). Communication breakdown between the healthcare providers may lead to omitting pertinent information or communicating misleading, false, untimely, and deficient information.

Salzwedel et al. (2016) reported that the loss of pertinent patient information during non-standardized intraoperative anesthesia handovers among healthcare providers is a potential link between several anesthesia care providers and post-anesthesia care complications. The researchers noted that non-standardized handovers lead to loss of vital patient information, resulting in high risks of delays, suboptimal care, inefficiencies, and even harm to the patient (Salzwedel et al. 2016). Intraoperative anesthesia handoffs are linked to adverse patient outcomes, implying that standardization would lead to better patient outcomes. Gibney et al. (2016) noted that about 64% of anesthesia providers are not using standardized handover procedures, and most of the healthcare providers felt that they received inadequate handover. The researchers observed that communication skills are the most limiting factor in the care quality of non-standardized anesthesia provider handovers. They argued that poor communication skills and human errors could be reduced when making anesthesia handoff reports by adopting a standardized checklist tool (Gibney et al. 2016). While evaluating the impact of non-standardized handovers between anesthesia providers and post-anesthesia care sections, Abraham (2021) established that about 80% of anesthesia providers provided and 57% post-anesthesia care providers received incomplete handoff reports within one of study, and 25% of the providers reported negative patient outcome caused by insufficient handover (Abraham 2021).

To reduce the variability in quality and quantity of information exchanged between the anesthesia team and post-anesthesia care unit (PACU), most healthcare institutions have adopted standardized handoffs, including SBAR protocol, to promote the quality exchange of information between healthcare providers and ensure patient-centered and safe care. According to Shahid and Thomas (2018), SBAR protocol, defined as a situation, background, assessment, recommendation, developed by Kaiser Permanente in 2003, has proven effective in shaping conversation between healthcare providers concerning situations requiring immediate attention. The model was originally introduced in the healthcare environment to facilitate nurse-doctor communication and patient information in acute care conditions (Shahid & Thomas 2018). However, it has proven to enhance communication satisfaction in the healthcare setting among care providers and improves the perception that communication is clearer, more straightforward, and more precise. The SBAR protocol encompasses, with the first one being the situation and why the nurse is calling the physician. Second is the patient’s background information, which includes a review of the chart before communicating about the situation. Third, we have the assessment, which concerns evaluating the patient’s present status (Shahid & Thomas 2018). Lastly is the recommendation, which entails providing a solution to the problem based on collected and evaluated information to ensure continued patient care (Shahid & Thomas 2018). The role of SBAR protocol in ensuring effective communication and continued patient care and safety has been stressed and supported by different health specialists, including anesthesia, perioperative and postoperative medicine, emergency medicine, and pediatrics, among others.

Electronic Tools for Handoffs: EHRs and Their Effectiveness Of In Improving Care Outcomes

            The healthcare sector has invested millions of dollars in transitioning to electronic health record (EHR) systems to enhance safety, accuracy, and efficiency. However, despite the advancement, handoff between healthcare providers is still acknowledged as a significant source of communication breakdown. But with proper implementation and training, EHR systems are projected to significantly improve healthcare efficiency, information sharing, and patient safety (Becker 2021). EHR systems contain a wealth of information concerning the patient and can optimize record keeping and documentation, though it is still faulted for lacking the mechanism to collect pertinent data such as telling a patient’s story or painting a picture on the patient. Besides, current EHR users cannot share subjective data, including warnings or opinions. Such limitations concerning the current EHRs used for handovers have prompted the development of HER-based handover tools (Coustasse et al., 2018). According to Becker (2021), implementing EHR-based handover tools has significantly improved communication, workflow, continuity, and quality of care in many healthcare settings embracing the technologies. The researcher argued that anesthesia nurses’ electronic checklist intraoperative handover led to enhanced communication and information retention. Adopting an EHR-based handover tool or electronic checklist also led to a significant number of anesthesiologists who could recall vital patient information when requested after handover and the type of medication and fluids administered (Becker 2021).

Hoover (2017) observed that one primary benefit of EHR is enhancing eligibility. The researcher argued that illegible handwriting from physicians, pharmacists, and nurses had been the prime cause of medication errors for decades. The researcher found that about 60% of medication errors in one of his sources were caused by poor handwriting (Hoover 2017). Besides, managing medication and other health information through EHR enhances patient outcomes over time. EHR minimizes the negative effects of medication events by about 52%. With advancements in technology, some EHR systems are even designed to integrate bar code medication scanning technology, alerting the nurses whenever they scan wrong medication (Hoover 2017).

Another way EHRs improve clinical and treatment outcomes is by reducing tests duplications and enhancing overall treatment efficiency. Some EHR systems can store radiology results, making them accessible within the system application if the physicians want to assess the X-ray or view reports from the radiologist. EHRs make clinical records accessible at any time by all the clinicians involved in the patient’s treatment process (Heath 2016). However, some EHR features, such as the ability to scan and store X-ray information, present additional designs and costs and are not available to all EHRs.

The Health Insurance Portability and Accountability Act of 1996 demands that health organizations safeguard all protected patient information. However, most providers struggle to keep such information safe. EHRs make it easier to safeguard protected health information, improving accountability using security and audit trail features that provide details of who has accessed the medical information at every particular time and the activities they conducted while accessing such records (Shah & Liebovitz, 2017). With EHRs, only authorized users can access health information, keeping the patient records safe from non-authorized users. Besides, patients can access their health information using patient portals to read and even print and send the information to providers (Hoover 2017). Such features allow the patient to be part of an advocate for their health care.

Goal and Objectives

The project’s overarching goal is to implement an EHR-based Standardized Handoff Report to enhance communication between anesthesia providers and post-anesthesia care unit (PACU) Nurses to reduce medical errors during handovers caused by variation in communication and ultimately guarantee patient safety and continuity of care. The highest portion of preoperative errors, including over 43% of communication breakdown occurs because of poor handoff between anesthesia providers and post-anesthesia care unit (PACU), putting patient safety at risk (Randmaa et al., 2017). Hence, the areas need improvement.

Objectives                                                            Evaluation

Objective#1: Design and implement an EHR-based, e-handoff tool to reduce errors during information sharing between anesthesia providers and PACU nurses.	Evaluate pre-and post- post-anesthesia outcomes to assess the tool’s efficiency by reducing unforeseen ICU admissions and a decrease in unexpected patient adverse events.
Objective#2: Implement an anesthetic tool integrating the SBAR protocol	Evaluate the relevance and efficiency of the tool based on how the information shared between the anesthesia providers, and PACU nurses are logical and structured in a succinct format.
Objective#3: Initiate training of anesthesia providers and PACU nurses to improve their knowledge about the technology.	Assess the staff challenge with the technology post-implementation, including communication problems and situational awareness.

Market/ Financial Analysis

Market or financial analysis of a healthcare project includes assessing the project’s financial implications, involving the healthcare organization’s past, present, and future financial performance based on the implemented idea or technology. It compares the facts about the healthcare organization over time relative to related organizations within the industry. The financial cost of this project will include the cost of a consultation with medical IT experts, medical experts, and the cost of materials, data analysis, staff, and medical record review. The project team will receive financial support from local authorities and community partners in grants to facilitate research, training, and implementation. However, the project will lead to significant cost savings for hospital admissions and Medicare at 36% and 26%, respectively.

Proposed Project Plan

Project Method/Design

The project will adopt a pretest-posttest design where similar assessment measures are provided to healthcare providers being surveyed before and after they have been exposed to the technology. The assessment measures are used to establish if there is any change attributed adoption of the e-handoff tool prototype. The pre-and post-implementation assessments will be essential to determine the effectiveness of the electronic handoff process in enhancing information exchange. The hospital’s EHR will be accessed to obtain pertinent patient information for treatment planning and future implementation. The researcher will assess the approach, tools, and handoff reporting systems currently used between anesthesia practitioners and PACU nurses. A provider questionnaire will be issued to assess the providers’ views on anesthesia-specific handoff tools.

Project Inputs

The estimated budget for this project is about $8,000, which goes to the cost of a consultation with medical IT experts, medical experts, materials, data analysis, staff, medical record review, and the development of the EHR-based e-handoff tool prototype. The researcher will seek financial support from community partners and local authorities in the form of grants. The hospital EHR will provide key patient data for planning.

Project Timeline

Proposal Development	November 10, 2021- December 10, 2021
Project Implementation	January 5- April 5, 2022
Staff Training	April 10 – May 10, 2022
Project Evaluation	May 15, 2022 – June 15, 2022
Project improvement	June 20, 2022- onwards

Evaluation/ Measurement Plan

The project will be evaluated based on the attainment of the objectives discussed earlier. The effectiveness of implementing an EHR-based e-handoff tool will be assessed on the number of errors during information sharing between anesthesia providers and PACU nurses before and after the program is implemented. The effectiveness of the SBAR tool will be assessed based on how the information shared between the anesthesia providers and PACU nurses is logical, structured in a succinct format. The outcome of the staff training will be evaluated based on their response to communication challenges or ease after the program implementation.

Ethical Implications

With the SBAR tool and EHR-based handoff tool, the anesthesia providers and PACU nurses will act in the patient’s best interest, reducing harm according to the ethical principle of nonmaleficence. The ethical principle of nonmaleficence advocates for the patient’s obligation not to harm the patient. There will also be a clear and concise transfer of patient information, reduce sentinel events, improve patient safety according to the ethical principle of beneficence. The principle of beneficence requires the healthcare provider to act to the patient’s benefit, protect the rights, and remove conditions that can lead to harm (Doody & Noonan, 2016).

Conclusion

Overall, effective communication and exchange of patient information during the handoff between healthcare teams are critical to nurturing continuity and safe patient care. However, many healthcare providers acknowledge poor communication and lack of standardized handoff procedures, jeopardizing patient safety and continuity of care. The proposed project aims to implement an EHR-based Standardized Handoff Report to enhance communication between anesthesia providers and the PACU team to reduce medical errors during handovers caused by variation in communication and ultimately guarantee patient safety and continuity of care.