Quality Improvement Student Project Proposal: Improvi 821439

QUALITY IMPROVEMENT STUDENT PROJECT PROPOSAL: IMPROVING HANDOFFS IN SAN FRANCISCO GENERAL HOSPTITAL’S EMERGENCY DEPARTMENT TMIT Student Projects QuickStart Package

Set in the high-pressure environment of the emergency department (ED), the focus of this project is on improving patient handoffs at San Francisco General Hospital (SFGH), a facility serving over 1.5 million residents with only one Level 1 Trauma Center. Overcrowding, noise, and the inherently chaotic nature of ED settings create significant challenges to effective communication during shift changes. This project aims to address these issues using established quality improvement methodologies, specifically the Plan-Do-Study-Act (PDSA) cycle, to standardize handoff protocols and enhance patient safety.

Paper For Above instruction

Emergency departments are critical yet tumultuous settings characterized by high patient volume, limited privacy, and frequent interruptions, all of which compromise effective communication during patient handoffs. These transitions, especially during shift changes, are vulnerable points for information loss, misunderstandings, and ultimately, adverse patient outcomes. Recognizing the gravity of these issues, this paper proposes a structured approach to improving handoffs in SFGH’s ED by implementing standardized communication protocols such as SBAR (Situation, Background, Assessment, Recommendation).

Background and Significance

Effective communication during patient handoffs is essential for maintaining continuity of care and ensuring patient safety (Apker et al., 2007). The Joint Commission emphasizes standardized sign-out procedures as a vital component in reducing preventable errors (JCAHO, 2006). Despite this, studies reveal that many EDs rely on verbal, unstructured handoffs often conducted in noisy hallways, fostering misinformation and missed details (Sinha et al., 2007). At SFGH, handoffs are frequently informal and non-standardized, involving verbal exchanges in less-than-private areas, thus increasing risks for miscommunication.

Barriers to Effective Handoffs

Key barriers identified include physical constraints, such as noisy hallways; social dynamics, such as hierarchical communication patterns where residents may hesitate to question attendings; and general communication barriers, such as lack of standardization and time pressure (Solet et al., 2005). These factors cumulatively jeopardize patient safety by increasing the likelihood of incomplete or inaccurate transfer of critical information.

Goals and Objectives

The primary goal is to improve patient safety, content reliability of handoffs, and provider satisfaction by achieving 100% compliance with the standardized SBAR protocol within 18 months. Specific objectives include implementing structured communication, reducing medical errors during shift changes, and enhancing team cohesion during handoffs (Owens et al., 2008).

Proposed Intervention

Employing the Institute for Healthcare Improvement (IHI) model, the intervention involves adopting the SBAR communication tool, tailored to the unique environment of SFGH ED. An initial small-scale PDSA cycle will be conducted with early adopters—comprising select attendings and residents—focused on developing an SBAR template, possibly using index cards or digital formats to facilitate quick reference during busy shifts.

The plan includes strategies to mitigate physical and social barriers by creating a designated, private space for handoffs and fostering open communication channels across hierarchies. Training sessions will be held to familiarize staff with SBAR, emphasizing its benefits for patient safety and efficiency.

Subsequent PDSA cycles will involve larger groups, including opinion leaders like the Chief Resident, to promote acceptance and adherence. Feedback from initial cycles will inform refinements, ensuring the protocol aligns with workflow and provider preferences.

Implementation Strategy

The initial step involves identifying early adopters and process owners committed to this change. These champions will pilot the SBAR protocol, evaluate compliance, and report challenges. Addressing resistance, particularly from providers wary of added time, will involve emphasizing the protocol’s efficiency and safety benefits, supported by evidence from literature (Wilson, 2007).

Engagement of leadership will be crucial to sustain momentum. Administrators and senior clinicians will be encouraged to endorse the initiative publicly, influencing culture change. Regular training, display of visual aids, and integration of SBAR into routine documentation will reinforce adherence.

The project will utilize continuous PDSA cycles, gradually expanding from pilot teams to the whole ED, with measurement of compliance rates and provider satisfaction to evaluate progress.

Measurement and Evaluation

Key metrics include adherence to the SBAR format measured via an all-or-none compliance indicator, and provider satisfaction gauged through surveys focused on perceived safety, clarity, and time efficiency. Additionally, tracking the incidence of communication-related errors or near misses will provide outcome measures aligned with patient safety objectives (Horwitz et al., 2008).

Data collection will be performed pre- and post-intervention, allowing for statistical analysis of improvement and identifying areas needing further refinement.

Barriers to Implementation

Potential obstacles include resistance from providers accustomed to current practices, hierarchical barriers discouraging open communication, and logistical challenges in modifying physical space and documentation workflows. Addressing these will require strong leadership support, ongoing education, and a culture that values safety over status quo.

Cost Considerations

Implementation relies mainly on human resources dedicated to training and process redesign, with minimal financial costs. However, anticipated savings include reduced medical errors, shorter length of stay, and improved staff satisfaction, thereby justifying the initial efforts and investments.

Conclusion

By standardizing handoff communication through SBAR, leveraging PDSA cycles for continuous improvement, and engaging clinical staff and leadership, SFGH can significantly enhance patient safety and provider satisfaction. The systematic approach aligns with national healthcare quality standards and contributes to a safer, more efficient emergency care environment.

References

  • Apker, J., Prosdahl, S. L., & Hoskins, W. (2007). Communicating in the "gray zone": perceptions about emergency physician-hospitalist handoffs and patient safety. Academic Emergency Medicine, 14(10), 884–894.
  • Joint Commission on Accreditation of Healthcare Organizations. (2006). Improving Handoff Communications: Meeting National Patient Safety Goal 2E. JCAHO Perspectives on Patient Safety.
  • Horwitz, L. I., et al. (2008). Dropping the Baton: A qualitative analysis of failures during the transition from emergency department to inpatient care. Annals of Emergency Medicine.
  • Wilson, M. J. (2007). A template for safe and concise handovers. Medsurg Nursing, 16(3), 201-206.
  • Solet, D. J., et al. (2005). Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Academic Medicine, 80(12), 1094–1099.
  • Owens, P. G., et al. (2008). Improvement report: Improving resident-to-resident patient care handoffs. Institute for Healthcare Improvement.
  • Hall, R. (2010). Patient flow: Reducing delay in healthcare delivery. Second edition.
  • Garcia, C., & Schaffer, M. (2010). Population-based public health clinical manual: The Henry Street model for nurses. Second edition.
  • Lowers, J. (1998). Medical guidelines and outcomes at work: Approaches to improving care and lowering costs. Capitol Publications.
  • Institute of Medicine (IOM). (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press.

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