Safety of Using a Computerized Rounding and Sign-Out System to Reduce Resident Duty Hours

Eaton, Erik G. Van; McDonough, Karen; Lober, William B.; Johnson, Eric A.; Horvath, Karen D.

doi:10.1097/acm.0b013e3181e0116f

Cited by 48 publications

(65 citation statements)

References 20 publications

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“…Only 1 of the 37 studies in our review used a randomized crossover design, 40 and 4 (11%) used nonrandomized control groups. 21,28,30,38 A recent editorial notes that ''randomization is not the 'gold standard' for medical education research,'' 55 but it emphasizes that use of ''.…”

Section: Discussionmentioning

confidence: 99%

“…38 In 9 studies (24%), perception of patient safety and/or quality of care improved 22,27,31,36,39 ; better patient management 21,25 or fewer near misses 30 were reported; and there was a reduction in missed patients. 34 However, a randomized crossover study found no statistically significant differences in resident-reported unexpected events, medical errors, or adverse drug events when comparing the electronic handoff system to the standard systems used (ie, written lists, card based, or a team-developed spreadsheet), 40 and another study found no difference in reported unexpected events pre-to postimplementation of a new electronic handoff system. 41 Residents responding to a postcall survey reported an unexpected patient event that should have been anticipated during handoff in about onethird of patients in the old as well as the new system.…”

Section: Self-reported Measuresmentioning

confidence: 99%

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Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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Background Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. Objective This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. Methods We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. Results Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. Conclusions The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.

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Section: Discussionmentioning

confidence: 99%

Section: Self-reported Measuresmentioning

confidence: 99%

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

View full text Add to dashboard Cite

show abstract

“…Furthermore, EMR-integrated handoff systems have been shown to facilitate patient care handoffs, which might otherwise be "haphazard and error prone." 2,6,7 In June 2006, Bernstein et al 8 implemented an EMR-integrated electronic handoff tool on the medical/surgical wards at Lucile Packard Children's Hospital (LPCH) and documented its rapid adoption, improved physician workflow and improved physician satisfaction. The handoff tool was not adopted in the LPCH neonatal intensive care unit (NICU), where the layout of a well-established standalone Microsoft Access sign-out database better addressed the needs of the unit.…”

Section: Introductionmentioning

confidence: 99%

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

2011

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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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“…The sign-out tool is sufficiently flexible to be used by the team for prerounding and team rounding activities. 11 As another benefit, medical students gain exposure to the tool, which provides an opportunity to teach the importance of reducing errors during transitions of care.…”

Section: Introductionmentioning

confidence: 99%

Toward “The Genius of the AND”: Balancing Professionalism and Duty Hour Requirements in Graduate Medical Education

Stoller¹,

Isaacson²,

Nielsen³

2011

Journal of Graduate Medical Education

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Although enhancing professionalism and ensuring compliance with duty hour regulations both represent important priorities of current graduate medical education, tension in reconciling these goals has been expressed. The term tyranny of the OR has been coined to express the assumption of dichotomous thinking, that is, that we assume we must choose between seemingly competing goals. In contrast, because there is powerful creative value in adopting a bridging mindset, an alternative state called the genius of the AND has been defined to express the benefits of reconciling perceived competing goals.

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Safety of Using a Computerized Rounding and Sign-Out System to Reduce Resident Duty Hours

Abstract: Managing information for sign-out and rounding with the UW Cores system, to reduce time spent in recopying patient data and in rounding on patients, improved continuity and enhanced resident efficiency without weakening systemic defenses against error or jeopardizing patient safety.

Cited by 48 publications

References 20 publications

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

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

Toward “The Genius of the AND”: Balancing Professionalism and Duty Hour Requirements in Graduate Medical Education

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