Handoff Method Research Articles

Development of nursing handoff competency scale: a methodological study

BackgroundNursing handoff competency is the ability of the nurse performing the handoff to select and interpret the necessary information for patient care and to convey it efficiently to the nurse accepting the handoff. Nursing handoff is an important nursing task that ensures nursing care continuity, quality and patient safety. This study aimed to develop a scale to measure nursing handoff competency and verify its validity and reliability.MethodsThis study adopted a methodological design. A research process included three phases: (1) scale development (literature review and interviews); (2) scale validation (validity and reliability); (3) standard setting. Data were collected from 496 clinical nurses currently working in hospital wards, intensive care units, and emergency rooms, and who independently perform a handoff in South Korea.ResultsThe final scale comprises a self-reported 4-points Ilert scale with 25 items based on four factors: knowledge on handoff methods, identification of patient information, judgment and transfer of nursing situation, and “formation of supportive relationships. Construct validity, criterion-related validity, and discrimination validities were verified and the fitness of the scale revealed good results in confirmatory factor analysis. The Cronbach’s α of the whole tool was.912 and the cut-off score for satisfied/unsatisfied was.72.ConclusionsThe developed scale can evaluate the nurse’s handoff competencies and determine whether training is necessary. The measurement results of the scale can be used to select training subjects and compose the contents of the education program.

Don't interrupt me! development of a handoff education bundle to simulate the real world.

Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff. A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum. Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff. Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses. Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Handoff performance analysis of PMIPv6‐based distributed mobility management protocol‐urban scenario

SummaryMobility management allows the networks to track down a mobile user's location for sending datagrams and to retain the connection when the user changes its location points repeatedly. Whenever a node switches between one base station and another, the connectivity is maintained through a process called handoff management. For real‐time traffic implementations in wireless network communications, handover performance is essential. A mobile node is blocked from transmitting and receiving a datagram for a longer time as the handover delay increases. Unacceptable handover delays are common in real‐time communication services. To guarantee smooth connectivity and continuous provision of services, effective handoff methods are required. The handoff efficiency of network‐based distributed mobility management (DMM) is studied extensively in this article, along with a comparison to PMIPv6. We specifically investigate how handover delay, session recovery, and packet loss are influenced by cell radius. From the analytical and simulation findings this paper concludes that network‐based DMM performs better than PMIPv6.

Sustainability of an Operating Room to Pediatric Postanesthesia Care Unit Handoff Tool

The purpose of this quality improvement (QI) project was to reintroduce and assess the feasibility of a standardized, electronic health record (EHR) handoff tool and to evaluate the sustainability of a structured, team-based approach in a pediatric postanesthesia care unit (PACU). This QI project used an observational pre-post design using two separate convenience samples of handoffs and perianesthesia providers. A standardized EHR handoff tool was reintroduced for operating room to pediatric PACU handoff communication. Handoffs between anesthesia providers, surgery team members, and PACU nurses were observed pre- and postreintroduction of the EHR handoff tool. Anesthesia providers and PACU RNs received training for giving and receiving handoffs and were provided directions on locating the EHR handoff tool. A bedside audit of items communicated for the six handoff phases (introductions, situation, background, assessment, recommendations, and questions), handoff duration, team member participation, and handoff tool utilization were performed for 149 handoffs pre- and 146 handoffs postimplementation. To evaluate sustainability, the audits were compared to postimplementation data from the 2014 pilot handoff project. Following reintroduction, EHR handoff tool use increased from 4% to 19%. There was a statistically significant increase in items communicated for three of the six handoff phases when using the EHR tool (P < .05). There was no statistically significant increase in handoff duration (mean=3.66 minutes, SD=1.57 minutes) with the EHR handoff tool. Surgical team member presence for the team-based handoff increased from 90.7% pre to 95.9% post. Provider compliance with the team-based handoff approach, which includes a PACU RN, surgical team member, and anesthesia team member present for handoff, was sustained and increased 6 years postimplementation. Feedback from anesthesia providers and PACU RNs indicated mixed reports of satisfaction with the EHR tool, perceived handoff efficiency, and consistency in both giving and receiving handoff. Adherence to five of the six structured handoff phases, except introductions, was sustained and even improved 6 years following implementation. Evidence-based practice for handoff communication supports the use of a team approach and standardized EHR handoff tools. The reintroduction of a standardized EHR handoff tool improved the completeness of information transfer, yet did not lead to widespread adoption nor improved user satisfaction. There is an ongoing need to identify adoptable and sustainable perioperative handoff methods.

Mastering the Patient Handoff

Mastering the Patient Handoff

Virtual Adaptation of Resident I-PASS Training Session During COVID-19.

IntroductionEffective communication during the patient handoff process is critical for ensuring patient safety. At our academic medical center, first-year interns complete hand-off training before starting clinical rotations. The purpose of this study was to evaluate a virtual handoff training for residents as an alternative to in-person sessions due to limitations imposed by COVID-19.MethodsFifty residents were administered pre/post surveys to gauge the helpfulness of the training for clinical practice, familiarity and confidence in providing a hand-off, and whether they would recommend the virtual format for incoming interns. Additionally, faculty rated the virtual form of the hand-off activity, made comparisons to in-person sessions, and assessed the helpfulness of the session for residents in clinical practice.ResultsForty-four residents (88%) and 11 faculty (85%) completed surveys. After the training session, residents who received instruction and feedback reported significant improvements in familiarity with the hand-off tool and confidence in their hand-off abilities (both p < 0.001). Both residents and faculty were satisfied with the virtual format of hand-off training. Most faculty felt the virtual platform was comparable to in-person sessions and would recommend ongoing use of the virtual platform when in-person sessions were not possible.ConclusionsTeaching hospitals mandate resident training to include strategies for a uniform hand-off method to avoid medical errors. Adaptation to a virtual platform can be a successful instruction strategy, allowing for didactic and interactive sessions with direct faculty observation and feedback.

Improving Electronic Patient Handoff in an Orthopedic Residency using the Listrunner© Application.

IntroductionMiscommunication during shift change and other handoff events is a common source of malpractice claims and patient-care errors. An efficient patient handoff system is imperative to prevent miscommunication. Owning to limitations with our current handoff system and to an ever-increasing reliance on electronic health information, our residency program sought to modernize our handoff method.MethodsTo improve handoff communication, the HIPAA-compliant application Listrunner© was adopted. Members of the orthopaedic trauma team were oriented to the new application. Change-of-shift patient handoff was transitioned from the current email system to List-runner©. After three months of using the new application, a web-based questionnaire was administered to all members of the care team to assess their experiences, including perceived benefits and limitations of the Listrunner© application.ResultsSeventeen orthopaedic resident physicians and three orthopaedic trauma attending physicians completed the survey. While almost half of the respondents were satisfied using email as a checkout tool, more than half of study participants indicated that it lacked security and several users believed there was a need for improvement. Most indicated that Listrunner© was easy to use, improved clinical efficiency, and improved patient care and safety. Seventeen of 20 respondents reported that they would like to continue using Listrunner© as a check-out tool.ConclusionsThe Listrunner© application was adopted quickly by our orthopaedic trauma team, whose members opined that the application increased the efficiency and accuracy of handoff when compared to the previous secure email system.

Echo state neural network-assisted mobility-aware seamless handoff in mobile WSNs

Strong mobility in Wireless Sensor Networks (WSNs) may disrupt an existing link between two communicating nodes. Because many Medium Access Control (MAC) protocols cannot adapt to the strong mobility of nodes, facing a decaying link, a node usually chooses to continue its data communication until the current link is terminated, and then searches for a new relay node to build a better connection. However, this will cause serious transmission latency. To tackle this problem, this paper proposes an echo state neural network-assisted mobility-aware seamless handoff method, which enables a node to handoff communication seamlessly to a more reliable link while maintaining communication over the current connection, and the current connection will be interrupted only after a new link is set up. To demonstrate the superiority of handoff, by taking the cattle monitoring as an example where nodes move at a constant speed, this paper designs a static-oriented Beacon-Initiated MAC (BI-MAC) protocol, develops a distance threshold as the handoff initiation signal, predicts future locations of nodes with a machine learning-based Echo State Network (ESN), formulates a mobility-aware seamless handoff module on top of the BI-MAC, and compares the data communication latency using and not using the handoff. Both the analytical and NS2 simulation results show that the time to set up a new link is much longer than the handoff latency. The one-hop latency can be reduced by at least 42% with the handoff support. This figure can further grow with the increase in duty cycle, network density, and size of multi-hop links.

A novel optimized routing algorithm for QoS traffic engineering in SDN-based mobile networks

Nodes in mobile networks change position randomly and quickly so modify their attachment point to the network. A most suitable method for handoff in core of the network is MPLS. For MPLS-TE, the most critical issue is LSP configuration. The goal of the routing algorithms in MPLS-TE is resource management and satisfy QoS metrics. The promising new SDN architecture can be a useful help to MPLS-TE due to its good features. This paper introduces a novel and low complexity SDN-MPLS algorithm. The proposed algorithm advances bandwidth-restricted routing as it trade-offs between network load balancing, route length, energy-saving with low complexity in mobile networks.

Streamlining Tactical Operator Handoffs During Multi-Vehicle Applications

Increased automation has shifted the operator control paradigm from a single operator controlling a single vehicle, to multiple operators collaborating to control multiple vehicles; this paradigm is known as m:N. Many questions remain unanswered in this new operational paradigm about the division of assets as workload for individual operators varies over time. This paper explores the management of workload by enabling operators to temporarily handoff vehicles among each other. A study was conducted to explore both a manual and assisted method for performing handoffs during manipulated contingency scenarios. The assisted handoff method allowed subjects to easily choose and group nominal and/or contingency vehicles. The number of contingencies was also manipulated to determine the effect workload had on how pilots utilized the ability to handoff vehicles. Results show subjects performed handoffs more often when there were more contingencies and when the assisted handoff tool was available. In addition, the assisted tool made subjects feel more comfortable, enabling them to feel like they could take longer to resolve contingency situations. Lastly, even during contingencies, subjects were able to successfully complete secondary tasks.

Multi-VSM based fuzzy adaptive cooperative control strategy for MVDC traction power supply system

This paper studies the control of a medium-voltage DC (MVDC) traction power supply system for rail transit (RT). In order to optimize the ability of DC voltage fluctuation and frequency regulation of rail trains, a fuzzy adaptive cooperative secondary control strategy based on improved virtual synchronous machine (VSM) is proposed. Firstly, the improved VSM control strategy is adopted in the traction substations (TSSs), which makes the RT trains have the external characteristics of synchronous generator and have certain inertia and damping support capacity, so as to improve the ability of the RT traction system to cope with traction network transient changes. Secondly, the virtual inertia and virtual damping can be dynamically adjusted by the system frequency deviating from the nominal steady-state frequency, and the dynamic fuzzy adjustment can be carried out by the fuzzy logic system to slow down the frequency fluctuation. Then, due to the different power supply distances and parameter settings between multiple TSSs, cooperative control is used to coordinate local TSS perceptions of information between adjacent TSS to achieve consistency of frequency response of multiple TSSs under different parameters. Besides, a time-varying switching topology handoff method is considered to select the optimal communication topology between adjacent base stations. Finally, simulation results verify the effectiveness of the proposed control strategy.

Patient safety culture and handoff evaluation of nurses in small and medium-sized hospitals

ObjectivesThis study was conducted to investigate the current status of handoffs, perception of patient safety culture, and degrees of handoff evaluation in small and medium-sized hospitals and identified factors that make a difference in handoff evaluation. MethodsThis is a descriptive study. 425 nurses who work at small and medium-sized hospitals in South Korea were included in our study. They completed a set of self-reporting questionnaires that evaluated demographic data, handoff-related characteristics, perception of patient safety culture, and handoff evaluation. ResultsResults showed that the overall score of awareness of a patient safety culture was 3.65 ± 0.45, the level was moderate. The score of handoff evaluation was 5.24 ± 0.85. Most nurses experienced errors in handoff and most nurses had no guidelines and checklist in the ward. Handoff evaluation differed significantly according to the level of education, work patterns, duration of hospital employment, handoff method, degree of satisfaction with the current handoff method, errors occurring at the time of handoff, handoff guidelines, and appropriateness of handoff education time (P < 0.05). ConclusionFor handoff improvement, guidelines and standards should be established. It is necessary to develop a structured handoff education system. And formal handoff education should be implemented to spread knowledge uniformly.

MROM Scheme to Improve Handoff Performance in Mobile Networks

Mobile Router (MR) mobility supported by Network Mobility Basic Support Protocol (NEMO BS) is a Mobile IPv6 (MIPv6) extension that supports Host Mobility. Proposed Multihoming and Route Optimization for MANEMO (MROM) scheme is designed to provide Route Optimization (RO) and Multihomed in NEMO architectures. This paper proposes two novel schemes; MANEMO routing scheme and Multihoming-based scheme. These are to provide support for next generation networks. The proposed MROM scheme differs from other schemes for NEMO environment because it considers the requirements of more application flows parameters as packet lost delivery, handoff delay as well as throughput). Another difference is that not only the network infrastructure can begin the functionality of flow routing, but also an Edge Mobile Router (EMR) can do this flow for routing. Moreover, it utilizes the state of the art and presently active access network to perform the separation of each flow in mobile network. Thus, proposed MROM exhibits multihoming features and improves handoff performance by initiating flow-based fast registration process in NEMO environment. A handoff method is proposed with enhanced functionalities of the Local Mobility Anchors (LMA), Mobile Routers (MRs) and signaling messages with a view to achieve continuous connectivity through handoff in NEMO. Both analytical and simulation approaches are used. Analytical evaluation is carried out to analyze packet delivery lost and handoff delay of our proposed scheme. It was also shown that cost of signaling messages and packet delivery are contributing to total handoff cost. At the simulation part, network simulator 3 (NS 3) has been used as the tool to get performance metrics that have been considered like packet delivery ratio, handoff delay, and packet loss. Our proposed scheme (MROM) has been benchmarking to the standard NEMO BS Protocol and P-NEMO. In this paper, we discuss proposed MROM for next generation networks, providing detailed analysis with a numerical model, proposed MROM, by maximizing the handoff performance, has been justified to have better mobility support than the ordinary NEMO BS Protocol and PNEMO.

Trajectory planning and tracking control for autonomous parallel parking of a non-holonomic vehicle

This paper proposes autonomous parallel parking for a front-wheel steering vehicle, with highlights on a trajectory planning method and on a trajectory tracking control method. The trajectory planning problem is decoupled into the path planning problem and the longitudinal velocity planning problem to reduce the difficulty of the trajectory planning problem. First, a collision-free path by combining circle arcs with straight line is created to park the vehicle in one or more maneuvers on the premise of meeting the kinematic constraint of vehicle, and then the path is transformed into a continuous-curvature path using B-spline curve. Second, the longitudinal velocity is created using B-spline curve on the premise of meeting the performance constraints of driving and braking system. To execute the generated trajectory, a non-time reference path tracking sliding mode control strategy is deduced by Lyapunov stability theory, and a longitudinal velocity tracking proportional–integral control strategy is proposed based on smooth handoff method. Finally, the parking performance is verified based on model-in-the-loop simulation system.

Emergency Clinician Experiences Using a Standardized Communication Tool for Cardiac Arrest.

IntroductionSudden cardiac arrest remains a common and critical disease burden. As post-cardiac arrest care grows in complexity, communication between pre-hospital providers, emergency department personnel, and hospital consultants is increasingly important.MethodsThis study evaluated the use of a standard handoff tool between pre-hospital personnel and hospital staff, including emergency medical services (EMS), emergency department nurses, physicians, and cardiologists. Personnel were surveyed regarding attitudes surrounding the important aspects of cardiac arrest care, challenges faced, and preference of handoff mechanism.ResultsMost of the survey respondents (58, 76%) found that the initial rhythm was the most important factor in post-cardiac arrest care, followed by the presence of bystander cardiopulmonary resuscitation (CPR; 55, 72%) and the presence of ST-elevation on initial electrocardiogram (46, 61%). Both emergency physicians (7, 63%), as well as cardiologists (3, 100%), preferred to have this tool performed over radio prior to arrival in the emergency department.ConclusionThe importance given to various post-cardiac arrest factors varied amongst specialty and clinical background; however, all agreed on common features such as the initial rhythm, electrocardiogram (ECG) morphology, and the presence or absence of bystander CPR. Additionally, the timing and structure of how this information is delivered were further elucidated. This data will guide future handoff methods between specialties managing patients after cardiac arrest.

Stochastic approach for channel selection in cognitive radio networks using optimization techniques

Secondary Users (SU) are guided by Cognitive Radio Device in identifying a channel licensed to Primary Users (PU) when it is free. Whenever PU arrives, SU shall vacate and search for the alternate band by a conditional handoff. Existing handoff methods reduce the network’s efficiency. The proposed stochastic approach under hybrid Spectrum Hand-off is (SHO) employing the Invasive Weed Optimization (IWO) algorithm thus increasing the SHO efficiency in CR Networks. The proposed Centralized Cognitive Device monitors load balancing, minimizes handoff delay as well as the SU’s service time, conserves energy, speeds up the data transmission, supports the Internet of Things, multimedia applications including audio, live video streaming and still images over resource constrained WSNs. This algorithm is compared with the existing Genetic algorithm and Particle Swarm Optimization. The channel selection accuracy of the proposed IWO method is found to be 97.8% and it outperforms conventional methods. Besides, the pre-emptive resume priority M/G/1 queuing model is also utilized. This paper presents a complete system model along with a detailed study of its parameters proving the technique’s effectiveness.

MUACLP Modeling Unified Architecture of Cross Layer Parameters Strategy of Handoff for Next Generation Wireless Network

The Quality of Service and Quality of experience is always a goal of future generation wireless systems. A suitably designed handoff plays an important role in achieving these goals. The traditional methods of handoff for wireless systems pose challenges in handling the smooth transition in the heterogeneous architecture of future generation architecture. This paper induces a model for synchronization of seamless handoff for a mobile user from a unified access point of a large cell to the small cell. The study is carried out considering a novel analytical model for facilitating a better form of vertical handoff mechanism in order to facilitate communication over 5G networks. The modeling is carried out considering the efficiency of channel capacity as well as considering near real-time constraint of latency and throughput. The typical design assumption for the unified architecture of the model for the handoff is for future generation wireless network that includes various physical layer parameters. For an effective analysis, the study considers that the receiving node will be identified on the basis of the non-erroneous node as the idea is to increase the proper utilization of the network resources. The core agenda of the study will be to ensure that irrespective of any form of traffic intensity as well as variable resource availability, the proposed scheme should be able to offer an extensive communication with the seamless performance during handoff operation. The study outcome exhibits that the proposed system offers better vertical handoff performance in contrast to the existing system on various test cases.

Smart Handoff Technique for Internet of Vehicles Communication using Dynamic Edge-Backup Node

A vehicular adhoc network (VANET) recently emerged in the the Internet of Vehicles (IoV); it involves the computational processing of moving vehicles. Nowadays, IoV has turned into an interesting field of research as vehicles can be equipped with processors, sensors, and communication devices. IoV gives rise to handoff, which involves changing the connection points during the online communication session. This presents a major challenge for which many standardized solutions are recommended. Although there are various proposed techniques and methods to support seamless handover procedure in IoV, there are still some open research issues, such as unavoidable packet loss rate and latency. On the other hand, the emerged concept of edge mobile computing has gained crucial attention by researchers that could help in reducing computational complexities and decreasing communication delay. Hence, this paper specifically studies the handoff challenges in cluster based handoff using new concept of dynamic edge-backup node. The outcomes are evaluated and contrasted with the network mobility method, our proposed technique, and other cluster-based technologies. The results show that coherence in communication during the handoff method can be upgraded, enhanced, and improved utilizing the proposed technique.

Handoff Schemes in Mobile Environments

Vehicular ad-hoc networks are one of the most popular applications of Ad-hoc networks, where networks are formed without any sort of physical connecting medium and can be formed whenever required. It is an area in networks that has enjoyed a considerable amount of attention for quite some time. Due to the highly mobile environment where these networks find their usability, it can be understood that there are a lot of problems with respect to maintaining the communication links between the moving vehicular nodes and the static infrastructures which act as the access points (AP) for these moving vehicular mobile nodes (MN). The coverage area of each AP is limited and as such, the connections need to be re-established time and again between the MNs and the closest accessible AP. Handoff is the process involved here, which deals with selecting the optimal APs as well as the best network available for data transmission. In this article, the authors compare various handoff methods and categorize them based on the different approaches they follow.

Large scale structural acoustics in Sierra-SD

In this talk, we will present an overview of structural acoustics and model reduction capabilities in Sierra-SD (Structural-Dynamics). Sierra-SD is a massively parallel finite element application for structural dynamics and acoustics, having recently demonstrated the implicit solution of models with over 2 billion degrees of freedom and running on up to one hundred thousand distributed memory cores. Domain decomposition and MPI parallelism are used to split a large domain into many small domains that can be solved in parallel. Sierra-SD offers a wide range of capabilities for model reduction. For acoustic models, infinite elements and perfectly matched layers are available to reduce domain size. For structural models, Craig-Bampton style superelements are available to reduce specific components in the structural portions of the model. Various coupling and handoff methods between linear structural acoustics codes and nonlinear solid and fluid mechanics codes are used to reduce model size. Large-scale, realistic applications will be presented on models such as ship shock loading and vibration of reentry bodies. [Sandia National Laboratories is a multimission laboratory managed and operated by National Technology and Engineering Solutions of Sandia, LLC., a wholly owned subsidiary of Honeywell International, Inc., for the U.S. Department of Energy's National Nuclear Security Administration under Contract DE-NA-0003525.]