Abstract: Introduction Nursing handoff is essential to the delivery of high-quality care and patient safety. Consequences of inadequate nursing handoff are widely acknowledged in the literature, begin with unsafe transfer of patient care, and lead to decreased ability to anticipate risk, intercept hazards, and ultimately failure to rescue. Intensive Care Units (ICUs) almost exclusively employ a team-based care approach with multiple disciplines collaborating together and operating under a shared mental model to execute high-quality care (Lucrezia et al., 2020). Methods We aimed to improve the quality and efficiency of bedside nursing handoff with implementation of an EPIC-embedded, standardized, nurse handoff tool. This was a QI project using PDSA methodology with four cycles: baseline, nursing education, implementation, and tool optimization. The perception of handoff quality was measured utilizing the Handover Evaluation Scale (HES). The HES examines multiple aspects of nursing handoff communication including the relevance and comprehensiveness of information (information quality), the timeliness and efficiency of the process (efficiency), and opportunity to clarify and discuss information (interaction and support) (Losfeld et al., 2021). Nurses responded to the survey questions using a seven-point Likert scale with responses ranging from strongly disagree to strongly agree, with a neutral mid-point. Question within the modified Handover Evaluation Scale were: (1) The information I receive is up to date, (2) I am provided with sufficient information, (3) Information is easy to follow, (4) Important information is not always given to me, (5) I find handover takes too much time, (6) I am often given information that is not relevant to patient care, and (7) I’m given information in a timely fashion. Efficiency, or duration of handoff, was self-reported by the nurse for each individual patient. Random, but stratified sampling was used to ensure equal comparison of four nurses on dayshift and four nurses on night shift daily for 7 days with PDSA cycle 1, 3, and 4. Of the 4 nurses surveyed during both night and day shift daily, two were a 1:1 (nurse/patient ratio) assignment and two were a 2:1 (nurse/patient ratio) assignment ensuring consistent and equivalent data comparison. Results A total of 127 nurse handoffs were evaluated for quality and efficiency during this project. With implementation of the EPIC-based, standardized handoff tool, nurses’ perception of handoff quality significantly improved with increase in HES scores by as much as 53% from baseline. Efficiency of handoff also showed significant improvement with a 38% decrease in the median duration from 22 minutes to 13.5 minutes per patient at project completion. Compliance with the tool improved from 0% at baseline to 62% at the end of PDSA cycle two, and ultimately 70% at the end of the project. Conclusions Implementation of a standardized, EPIC-based handoff tool improved the quality and efficiency of nurse handoff within the Pediatric Cardiac Intensive Care Unit.
