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Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit

Abstract

Objective:

To evaluate the impact of integrating a handoff tool into the electronic medical record (EMR) on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit (NICU).

Study Design:

Prospective surveys of neonatal care providers in an academic children's hospital 1 month before and 6 months following EMR integration of a standalone Microsoft Access neonatal handoff tool.

Result:

Providers perceived sign-out information to be somewhat or very accurate at a rate of 78% with the standalone handoff tool and 91% with the EMR-integrated tool (P<0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration, 92% of providers were satisfied with the process of updating sign-out information (P<0.01) and 98% were satisfied with the printed sign-out document (P<0.01). Neonatal care providers reported spending a median of 11 to 15 min/day updating the standalone sign-out and 16 to 20 min/day updating the EMR-integrated sign-out (P=0.026). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P<0.01).

Conclusion:

Integration of a NICU-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and at least one aspect of workflow.

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Acknowledgements

We acknowledge all the members of the LPCH Information Services department who played a role in the development and implementation of the EMR-based neonatal handoff tool, with special thanks to Margie Godin, RN (Clinical Informatics manager for newborn care and obstetrics), Kiran Pandher (systems architect) and Irene Todd (programmer analyst) for their contributions to the project. We also thank Matthew Wood (clinical informatics, LPCH) for his assistance in the statistical analysis. Finally, we acknowledge Ashvin Sangoram, MD, PhD (former neonatal-perinatal medicine fellow, Stanford University School of Medicine), who developed the standalone Microsoft Access neonatal handoff tool that informed several design aspects of the EMR-integrated handoff tool.

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Correspondence to J P Palma.

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Appendix 1

Appendix 1

NICU sign-out survey

Table A1

Table 3 Table a1

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Palma, J., Sharek, P. & Longhurst, C. Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit. J Perinatol 31, 311–317 (2011). https://doi.org/10.1038/jp.2010.202

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  • DOI: https://doi.org/10.1038/jp.2010.202

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