Background: Emergency department (ED) overcrowding leads to detrimental results including increased morbidity and mortality, delay in evaluation of treatment, increased cost of care, increased length of stay, diminished staff satisfaction, increased ambulance diversion, and reputation damage for the entire institution (American College of Emergency Physicians, 2019). A study performed at three high volume community hospitals revealed inefficiency of nursing handover as one of the many contributors to prolonged ED length of stay (Salehi, 2019).
Local Problem: According to the 2018 Emergency Department Benchmarking Alliance (EDBA) data survey the average length of time from patient arrival to admission disposition was 188 minutes, the time from admission disposition to moving out of the emergency department into a room (boarder time) was 116 minutes. At a local large tertiary care center which this study will take place, the current boarder time was approximately 20 hours, while the time from room assignment to ED departure was over 180 minutes, exemplifying a critical need for intervention for this overcrowding.
Intervention: Two med-surg level inpatient units were involved in this study, WW3 and CVSDU. Three care handoff methods were reviewed, including telephone report, paper SBAR, and electronic SBAR. Inpatient bed assignment to emergency department departure times were collected on a weekly basis for both units. Data collection included 12 weeks of telephone report, paper SBAR, and electronic SBAR. The bed assignment to departure times for each care handoff method were compared utilizing a two-way ANOVA. At the end of the care handoff trial, nurses on the participating units participated in a voluntary survey where they indicated which care handoff method they preferred. Data were analyzed utilizing a cross-tabulation analysis.
Results: The average time from inpatient bed assignment to ED departure using telephone report was 100.125 minutes, paper was 108.29, and electronic was 99.5. While the electronic care handoff did have a lower average time than telephone and paper, it was not a statistically significant finding (P=0.878). A cross-tabulation analysis was performed to summarize the relationship between the unit employed on and the preferred care handoff method. Of the 9 survey respondents on CVSDU 7 preferred telephone report, 2 preferred the paper SBAR, while 0 preferred electronic. Of the 8 survey respondents on WW3, 6 preferred telephone, 1 preferred paper, and 1 preferred electronic. Of the 16 respondents from the emergency department, 0 preferred telephone report, 1 preferred paper, and 15 preferred electronic.
Conclusion: There was no statistically significant difference in times from inpatient bed assignment to ED departure based on the type of care handoff method utilized. ED nurses preferred electronic report, while inpatient nurses preferred telephone report. Although there was no statistically significant difference in the methods, the electronic care handoff was thought to be the most efficient for the emergency department and was adopted as the new practice throughout the hospital system.
Search Terms: Nurse handoff, care handoff, patient throughput, emergency department, emergency department throughput, SBAR.
Graves, Shelby, "Impact Of Care Handoff Methods On Emergency Department Throughput Times" (2022). DNP Research Projects. 56.