Use of Theory in Quality Innovations: Shift Change Protocol in the Emergency Department.

Abstract

Inconsistent and nonstandardized patient handoffs can increase the risk of adverse events. Using change theory may promote adoption of effective handoff processes. A Midwest emergency department (ED) had no standardized practice for shift change handoffs. Previous handoff quality improvement efforts had been unsuccessful. A pre/postintervention pilot project design was used. Nurses' compliance with the new handoff protocol was evaluated. Using Diffusion of Innovation (DOI) theory, an evidence-based shift change protocol was designed and implemented, which included a comprehensive handoff tool specific to the ED. Four elements in the new shift change process saw statistically significant improvements after implementation, including discussion of the patient's illness severity ( P = .001), synthesis of the patient's care ( P < .001), completing a bedside safety checklist ( P < .001), and providing a formal transition-of-care process ( P < .001). Using DOI theory may improve the adoption of new shift change practices.