Improving and Verifying Patient Handoffs

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Group Name

Improving and verifying Patient Handoff

Group members and e-mails

Surabhi Satam: ssatam3@gatech.edu

Siddharth Gupta: siddharth.gupta@gatech.edu

Ramakrishnan CH: ramakrishnan_ch@gatech.edu

Abstract/Blurb for the Open House

Click on the image below:

SBAR.jpg

Problem statement

Patient handoffs frequently occur in hospitals under the following circumstances:
• nurses changing shifts
• transfer from one hospital to the other
• intra hospital transfers between different care teams depending on the patient illness

During patient handoff critical information is transmitted from caregiver to caregiver and provider to provider. A large number of attempts have been made in past [see references] to make this process as streamlined and as well defined as possible. Currently the most upcoming and highly verified method of patient care information transfer is a technique called SBAR [2].

SBAR is a standard format which is nowadays used for patient handoffs. This is the written/textual form of handoff. Other than this there are situations where oral handoff also takes place. A nurse C may not convey the information in entirety to nurse D who is supposed to take over, as conveyed by the example below.

Day Shift Nurse: C
Night Shift Nurse: D
Patient: P
Allergies: Sulfa drugs (drugs containg sulphur), Anticonvulsants (Medication for epileptic seizures)
Medication: Chlorthalidone (high blood pressure)
Heart Rate: 89 bpm
Blood Pressure: 134/88
Temperature: 101 F

Handoff methodologies:
- SBAR
- Oral Handoff

Nurse C: Patient P is now your responsibility. His latest Heart Rate was 89bpm Blood Pressure was at 134/88. He is on the Chlorthalidone. Patient A is suffering from high blood pressure and fever.

We observe the following problems with the above oral method of communication.
1. Nurse C missed the following things: Dust Allergy, Temperature of the patient
2. The nurse may not remember to specify all the fields.

This can cause serious ill-effects on the patient’s health. Nurse D may not treat the patient for the allergy that was missed out. This might in turn have some other side effect.

Description of the solution

It has been observed that, nationally 70-85% of patient safety events are due to communication failures with grave consequences to patient care.

We propose a standard format for oral handoff communication. We also propose a method that verifies the information that the nurse C conveys to nurse D.

This is verified by a machine (computer or any other device). As shown in the figure below, nurse C switches on the verifier machine. This machine matches the fields against those residing in the database.

In case of any error, machine intervenes with a sound and the correct fields mentioned on the computer screen. This allows the nurse C to take a corrective action.

The important points that we will be targeting are as follows:
1. SBAR format in oral handoff
2. Time efficiency
3. Managing multiple handoffs at once.


SBAR (Situation, Background, Assessment, Recommendation/Recap): used in patient handoff communication

- SBAR is currently the communication standard of care in many Emergency departments of hospitals in the United States because it has been so effective in improving communication between all types of health care providers.
- Teamwork is critical to EMS and depends on effective communication.
- SBAR should be clear, concise and effective. It is evidence based and is designed for high risk communication
- It is most commonly used in Patient Handoff Communication.

Solution Architecture

Architecture diagram.JPG

The solution that we propose is explained in detail below:

1. Establish a common mode of communicating patient information between care teams by standardizing the SBAR format as the de-facto format. To encourage the usage of SBAR format and to verify the correct documentation according to SBAR format, we propose the following technological solution.

2. We are building an application that will act as an interface between two parties involved in the handoff. In our prototype setup we have two computers in either side of the oral handoff. Both these computers are connected to the central medical database where patient records and medical history are stored. The database also consists of all previous handoff text and audio for each patient.

3. The two parties would be communicating over phone for the oral handoff. They would be required to follow the SBAR format for exchanging information. Computers on both sides will listen to this conversation and record it as well.

4. The computers will also try and identify keywords that either party speak of and match those keywords to records in the database. If either of the parties leaves out some information or mentions some incorrect information or adds something new that is not present in the database, there would be popup or sound informing them that there is extra information available that might be valuable to the handoff conversation.

5. The prototype that we build can be ported on to a more portable medium like a smart phone or tablet pc.

Milestones

15 Nov – 19 Nov

Surabhi Satam - Explore more into the problem and get as many problem cases as possible so that we can select the best of them and implement solution from them.

Siddharth Gupta - Finalize the shortlisted fields from the SBAR to implement. Understand various tools that can be used for implementing the solution (sound recognition) etc.

Ramakrishnan C H - Start with of design possibilities and explore the best implementation techniques.


20th Nov – 30th Nov

Surabhi Satam - Develop the database tables and optimized database access queries.

Siddharth Gupta & Ramakrishnan C H - Pattern recognition Work : Accept the audio data and convert it to text. Also write programs to execute the database queries and pattern recognition code over SBAR shortlisted filed in the order.


1st Dec – 5th Dec
Surabhi Satam - Testing and documenting process. Fielding the in person scenario.

Siddharth Gupta - Wrap up the test cases and prepare for the presentation.

Ramakrishnan C H - Complete coding and its documentation and code cleanup etc.

Resource needs

• Two computers (Personal Laptops)
• One database Server (Personal Laptop)
• Visual Studio/Eclipse (Already have the copies)
• Audio Recognition tool (We might need to buy the license to the dragon naturally speaking, currently looking into the existing open source implementation).
• 2 – Microphone : (Laptop Microphones)

Main faculty coach you request

• Dr. Jeremy Ackerman
• Dr. David Zimring

Draft outline of the final report

• Summary
• Problem Statement
• Problem Detailed Description
• Scenario Description
• Solution Proposed
• Software Architecture
• Process to be followed
• Software Limitations
• Accuracy Analysis
• Scope of future Work
• Bibliography

Demo Description

Nurse A does a patient handoff to Nurse B. She verbally communicates the SBAR format which we verify with the system that we have built. In case of any mistakes on the part of nurse A, the machine/device prompts her to take the corrective action.


References

1. Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs Darrell J. Solet, MD, J. Michael Norvell, MD, Gale H. Rutan, MD, MPH, and Richard M. Frankel, PhD.
2. Improving Patient Safety through Provider Communication Strategy Enhancements. Catherine Dingley RN, PhD, FNP; Kay Daugherty RN, PhD; Mary K. Derieg RN, DNP; Rebecca Persing, RN, DNP.
3. Kohn LT, Corrigan JM, Donaldson MS, McKenzie D. To Err Is Human: Building a Safer Healthcare System, in Committee on Quality and Healthcare in America, Institute of Medicine. Washington, DC: National Academy Press, 2000.
4. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust.1995; 163:458–71.
5. Volpp KGM, Grande D. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003; 348: 851–55.
6. Lofgren RP, Gottlieb D, Williams RA, Rich EC. Post-call transfer of resident responsibility: its effect on patient care. J Gen Intern Med. 1990; 5:501–05.