Streamlining patient handoffs safely and efficiently has long flummoxed medical professionals. Numerous factors can impede clear communication between practitioners during transitions of care, among them being incomplete charts, forgotten or indecipherable instructions, and personal conflicts between providers.
Those mistakes could have grave consequences — according to the Joint Commission, as many as 80 percent of all hospital sentinel events stem at least in some part from handoff miscommunications.
It’s not easy changing the routines of providers, nor is establishing universal procedures that are useful for individuals with disparate backgrounds and responsibilities. But mobile software developers are stepping up to face the myriad challenges handoffs present. Utilizing smartphone and tablet platforms, they’re attempting to both stratify and simplify communication between caregivers.
A patient handoff is ideally marked by a face-to-face discussion between providers, outlining both a patient’s progress and their further instructions for care. Dr. Lyle Berkowitz, associate chief medical officer of innovation at Northwestern Memorial Hospital in Chicago, likens a handoff to engagement on Twitter.
“I always try to think of what I call a ‘handoff Tweet’ — what I can say in a small number of characters — because most doctors will want to summarize in a way that gets to the core of what’s going on,” he said.
If all goes well, according to Dr. Max V. Wohlauer, surgical resident at the University of Colorado Medical Center in Aurora, Colo., the handoff should function the same as a well-written user’s manual.
“Oftentimes the information we are trying to convey is just free text — it’s me saying, for example, ‘If the patient’s heart rate goes above 100, watch out, because it will be over 200 before you know it,’” said Wohlauer, lead author on the 2012 study, “The Patient Handoff: A Comprehensive Curricular Blueprint for Resident Education to Improve Continuity of Care.”
But a multitude of factors disturb handoffs, according to Mary Ann Friesen, nursing research coordinator for Falls Church, Va.-based Inova Hospital Systems, who has studied the handoff process extensively.
“Nurses need to have a way of transmitting information, and nobody is capable of remembering everything,” Friesen said. “What we tried to do at Inova was develop a standardized template nurses could use — the challenge is getting that into an IT system.”
But developers say they are finding mobile technology solutions to the quandaries handoffs present. Among them are Siva Subramanian, founder and chief operating officer of CareInSync in Santa Clara, Calif. The firm’s handoff app, Carebook, went live at Marin General Hospital in Greenbrae, Calif., and eight of its satellite facilities in December. The app allows for real-time communication between team members, customizable checklists and onscreen dashboards, among other components.
Subramanian’s firm studied evidence-based best practices of handoff models in order to formulate a mobile-based platform easing communication between practitioners and other staff at Marin General. “The challenge was taking these so-called rules and building a best-in-class process across a very dispersed and dynamic team that’s constantly changing,” he said.
Handoff app developers have had to find a balance between efficient standardization and useful customization. They have numerous factors to consider, among them team members working in different departments, specialties and professions.
In the mid-2000s, Berkowitz helped create ExpectED, a web-based app that allowed physicians to notify an emergency department of an incoming patient. But in the app’s early stages of testing, he discovered it wasn’t transmitting much information useful to triage nurses, who evaluated patients with an established scoring system.
“As the physician I could tell them as much as I could about the patient and their diagnosis, but in the end they had to use that scoring system,” he said. “The ability to get the information to the right person in the right place at the right time is most important.”
Some apps are being developed for nursing professionals, among them the Digital Nurse Assistant, developed by Xerox. The app platform, developed for tablet devices at using research conducted by PARC, a Xerox Company, consolidates patient information that previously may have been in discrete silos, according to Deri Plummer, a Xerox product leader based in Franklin, Tenn.
Each patient’s record contains the most relevant clinical information to support the nurses’ workflow. Nurses can also choose to be notified about specific events, such as when a medication arrives that is due to be administered, or if a patient is cleared to go home.
Plummer said that DNA would be especially helpful in avoiding “collisions” — those moments when nurses and ancillary staff need to provide care at the same time. This requires careful coordination.
“Different departments have different protocols and policies that they do that may not always complement the others,” she added. “So we can send in our researchers to say, ‘Here are the gaps and here are the opportunities to reduce costs and enhance the quality of care.’”
App developers must also consider their platform’s relation to electronic medical records (EMRs). Some extrapolate patient data from patient records, while others operate independently. Wohlauer said patients might not want some handoff information — such as notes about disruptive family members — included with their permanent medical records. “But it’s still helpful to know these nuances when you’re taking care of a patient.”
When Buffalo, N.Y.-based firm Cypress North Corp. launched its app Smart Sign Out with a pilot study this past September, it kept handoff information largely separate from the EMR, though the app does read information from patient records in order to avoid duplicate data entries.
“It’s a standalone software, and that’s intentional,” said Matt Mombrea, chief technology officer at Cypress North. “The sign-out procedure is kind of a unique procedure in hospitals. When information goes back into the EMR it becomes legal record, and that’s not really the purpose of the sign out — it’s a doctor-to-doctor communication tool.”
Handoff apps are likely to shore up information delivery, but providers must be certain not to favor them over face-to-face discussion, Wohlauer said, adding, “No technology will be a panacea.”
“What’s most important is face-to-face communication, then IT,” Friesen added. “If we’re only doing asynchronous communication, that’s only setting us up for problems.”
Nick Adams, co-founder and chief operating officer of Providence, R.I.-based Care Thread, said handoff apps can be developed with interpersonal communication in mind. His company’s app structures tasks and communications throughout the day, not just at handoff time.
“We recognize that people need to talk live,” Adams said. “So how do we help them make that connection more digitally and more seamlessly? Now they are going to have more time to sit down face-to-face and do their handoffs.”
Screenshot of Xerox Digital Assistant