Handoff Process Research Articles

Implementation of a Modified Bedside Handoff for a Postpartum Unit.

The most frequent cause of sentinel events is poor communication during the nurse-to-nurse handoff process. Standardized methods of handoff do not fit in every patient care setting. The aims of this quality improvement project were to successfully implement a modified bedside handoff model, with some report outside and some inside the patient's room, in a postpartum unit. A structured educational module and champion nurses were used. The new model was evaluated based on the change in compliance, patient satisfaction, and nursing satisfaction. Two months after implementation, there was an increase in nursing compliance in completing all aspects of the model as well as an increase in both patient and staff satisfactions of the process. Replicating this project may help other specialty units adhere to safety recommendations for handoff report.

Integrating Research, Quality Improvement, and Medical Education for Better Handoffs and Safer Care: Disseminating, Adapting, and Implementing the I-PASS Program

In 2009 the I-PASS Study Group was formed by patient safety, medical education, health services research, and clinical experts from multiple institutions in the United States and Canada. When the I-PASS Handoff Program, which was developed by the I-PASS Study Group, was implemented in nine hospitals, it was associated with a 30% reduction in injuries due to medical errors and significant improvements in handoff processes, without any adverse effects on provider work flow. To effectively disseminate and adapt I-PASS for use across specialties and disciplines, a series of federally and privately funded dissemination and implementation projects were carried out following the publication of the initial study. The results of these efforts have informed ongoing initiatives intended to continue adapting and scaling the program. As of this writing, I-PASS Study Group members have directly worked with more than 50 hospitals to facilitate implementation of I-PASS. To further disseminate I-PASS, Study Group members delivered hundreds of academic presentations, including plenaries at scientific meetings, workshops, and institutional Grand Rounds. Some 3,563 individuals, representing more than 500 institutions in the 50 states in the United States, the District of Columbia, Puerto Rico, and 57 other countries, have requested access to I-PASS materials. Most recently, the I-PASSSM Patient Safety Institute has developed a virtual immersion training platform, mobile handoff observational tools, and processes to facilitate further spread of I-PASS. Implementation of I-PASS has been associated with substantial improvements in patient safety and can be applied to a variety of disciplines and types of patient handoffs. Widespread implementation of I-PASS has the potential to substantially improve patient safety in the United States and beyond.

Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME.

Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one’s knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum.

Implementation of Particle Swarm Optimization Technique for Enhanced Outdoor Network Coverage in Long Term Evolution Network in Port Harcourt, Nigeria

This paper describes the development of optimized model for urban outdoor coverage in Long Term Evolution (LTE) network at 2300 MHz frequency band in Port Harcourt urban region, Nigeria. Signal attenuation and fluctuation remain amongst the major channel impairments for mobile radio communication systems. This arises as a result of model incompatibility with terrain and Line of Sight (LOS) obstruction of the channel signals. Some path loss models such as Okumura-Hata, COST 231, Ericsson 999, Egli and ECC-33 models were evaluated for suitability and compared with the modified model for the environments. The models were based on data collected from LTE base stations at three geographical locations in Port Harcourt namely- Rumuokoro, Eneka and Ikwerre roads respectively. The simulation was implemented using MATLAB R2014a software. The modified model was further optimized with some selected parameters such as Root Mean Square Error (RMSE) and Mean Absolute Error (MAE) using Particle Swarm Optimization (PSO) technique. The results obtained gave rise to 3.030dB for RMSE and 0.00162dB for MAE respectively. The results obtained from the PSO optimized model demonstrated a better performance which is suitable for cell coverage planning and smooth handoff processes.

Implementation of Particle Swarm Optimization Technique for Enhanced Outdoor Network Coverage in Long Term Evolution Network in Port Harcourt, Nigeria

This paper describes the development of optimized model for urban outdoor coverage in Long Term Evolution (LTE) network at 2300 MHz frequency band in Port Harcourt urban region, Nigeria. Signal attenuation and fluctuation remain amongst the major channel impairments for mobile radio communication systems. This arises as a result of model incompatibility with terrain and Line of Sight (LOS) obstruction of the channel signals. Some path loss models such as Okumura-Hata, COST 231, Ericsson 999, Egli and ECC-33 models were evaluated for suitability and compared with the modified model for the environments. The models were based on data collected from LTE base stations at three geographical locations in Port Harcourt namely- Rumuokoro, Eneka and Ikwerre roads respectively. The simulation was implemented using MATLAB R2014a software. The modified model was further optimized with some selected parameters such as Root Mean Square Error (RMSE) and Mean Absolute Error (MAE) using Particle Swarm Optimization (PSO) technique. The results obtained gave rise to 3.030dB for RMSE and 0.00162dB for MAE respectively. The results obtained from the PSO optimized model demonstrated a better performance which is suitable for cell coverage planning and smooth handoff processes.

A Model for Electronic Handoff Between the Emergency Department and Inpatient Units

BackgroundPatient handoffs between units can introduce risk and time delays. Verbal communication is the most common mode of handoff, but requires coordination between different parties. ObjectiveWe present an asynchronous patient handoff process supported by a structured electronic signout for admissions from the emergency department (ED) to the inpatient medicine service. MethodsA retrospective review of patients admitted to the medical service from July 1, 2011 to June 30, 2015 at a tertiary referral center with 520 inpatient beds and 57,000 ED visits annually. We developed a model for structured electronic, asynchronous signout that includes an option to request verbal communication after review of the electronic handoff information. ResultsDuring the 2010 academic year (AY) all admissions used verbal communication for signout. The following academic year, electronic signout was implemented and 77.5% of admissions were accepted with electronic signout. The rate increased to 87.3% by AY 2014. The rate of transfer from floor to an intensive care unit within 24 h for the year before and 4 years after implementation of the electronic signout system was collected and calculated with 95% confidence interval. There was no statistically significant difference between the year prior and the years after the implementation. ConclusionsOur handoff model sought to maximize the opportunity for asynchronous signout while still providing the opportunity for verbal signout when deemed necessary. The process was rapidly adopted with the majority of patients being accepted electronically.

Standardized ICU to OR handoff increases communication without delaying surgery

PurposeNo studies have examined preoperative handoffs from the intensive care unit (ICU) to OR. Given the risk of patient harm, the authors developed a standardized ICU to OR handoff using a previously published handoff model. The purpose of this paper is to determine whether a standardized ICU to OR handoff process would increase the number of team handoffs and improve patient transport readiness.Design/methodology/approachThe intervention consisted of designing a multidisciplinary, face-to-face handoff between sending ICU providers and receiving anesthesiologist and OR nurse, verbally presented in the I-PASS format. Anticipatory calls from the OR nurse to the ICU nurse were made to prepare the patient for transport. Data collected included frequency of handoff, patient transport readiness, turnover time between OR cases, and anesthesia provider satisfaction.FindingsIn total, 57 audits were completed. The frequency of handoffs increased from 25 to 86 percent (p<0.0001) and the frequency of patient readiness increased from 61 to 97 percent (p=0.001). There were no changes in timeliness of first start cases and no significant change in turnover times between cases. Anesthesia provider satisfaction scores increased significantly.Practical implicationsA standardized, team based ICU to OR handoff increased the frequency of face-to-face handoffs, patient readiness and anesthesia provider satisfaction within increasing turnover between cases.Originality/valueAlthough studies have identified the transition of patients from the ICU to the OR as a period of increased harm, the development of a preoperative ICU to OR handoff had not been described. This intervention may be used in other institutions to design ICU to OR transitions of care.

Attitudes Regarding Transitions of Care of Obstetric and Gynecology Patients in a County Hospital Setting [20I

INTRODUCTION: Handoffs and transitions of care have been a central part of patient safety goals at John Peter Smith Hospital. With twice daily shift changes for physician and nurses, the Department of Obstetrics and Gynecology introduced a new interdisciplinary team transition of care system. Initial anecdotal feedback suggested that the handoff process was suboptimal and communication efforts could be improved. The purpose of the study was to evaluate attitudes of faculty, residents, and nursing staff about a transition of care system and identify opportunities to improve the safety and quality of care involving antepartum, postpartum, and gynecology patients. METHODS: An anonymous online survey was administered to physicians and nurses participating in the new handoff system. The results were analyzed to identify opportunities for improvement. RESULTS: Responses were analyzed from 21 members of the interdisciplinary team. 47% of the respondents found the transition of care system helpful. 55% felt their goals for handoffs were accomplished. All respondents reported importance in addressing updates on patient plans of care and anticipated discharge dates. Content of handoffs should focus on the acute and critically ill patients. The attending physician, chief resident, and nursing team leaders should participate in the handoff process. CONCLUSION: Differences in goals and content focus between physicians and nurses contributed to suboptimal communication and handoffs. Identifying the deficits allows opportunities for improvement in transitioning care and ultimately the safety and quality of care provided to patients. Participation in the process should include faculty physicians, chief residents, and nursing leaders.

Energy-efficient target channel sequence design for spectrum handoffs in Cognitive radio networks

Cognitive radio is considered as an efficient way to improve the spectrum efficiency. As one of its key technologies, spectrum handoff can guarantee the transmission continuity of secondary users (SUs). In this paper, we address a new and more generalized spectrum handoff problem in cognitive radio networks (CRNs), by considering simultaneously energy efficiency, multiple spectrum handoffs and multiple channels. Furthermore, effects of the primary users' (PUs') arrival and service rate on the target channel sequence selection are also considered. In order to obtain the energy-efficient target channel sequence, we firstly analyze the energy consumption and the number of delivered bits per hertz in the spectrum handoff process, and formulate a ratio-type energy efficiency optimization problem, which can be transformed into a parametric problem by utilizing fractional programming. Then, we propose an algorithm combining dynamic programming with bisection (DPB) algorithm to solve the energy efficiency optimization problem. Our simulation results verify that the designed target channel sequence has better performance than the existing algorithms in terms of energy efficiency.

A Quality Improvement Approach to Standardization and Sustainability of the Hand-off Process

There is mounting evidence that communication and hand-off failures are a root cause of two-thirds of sentinel events in hospitals. Several studies have shown that non-standardized hand-offs have yielded poor...

Improving cancer treatment handoffs: Wilmot Cancer Institute’s (WCI) ASCO Quality Training Program experience.

139 Background: Ineffective handoffs contribute to gaps in patient care and medication errors, jeopardizing patient safety and leading to poor quality of care. Ineffective handoffs accounted for 59% of reported medication events at WCI Infusion Center. The completion rate of WCI’s existing electronic medical record (EMR) based free text handoff note for patients treated with anti-cancer therapy on the same day as a clinic visit was 32%. The project aim is to create an effective EMR integrated treatment handoff tool and establish standard workflow processes to ensure optimal communication among WCI providers for improved patient safety and quality of care. Methods: We convened a multidisciplinary team to develop an efficient and safe treatment handoff tool. WCI nurses were surveyed to evaluate the baseline state of the handoff process. Tool development was performed over a series of phases, including creation of a project charter and aim statement, outlining current workflow process, identifying gaps and limitations in the process, identifying potential causes of ineffective hand-off and using a Pareto chart to prioritize them. Utilizing the Situation-Background-Assessment-Recommendation framework, an EMR-integrated handoff tool with standardized workflow process was developed, along with an educational plan for the tool. Results: 52% (N = 22/42) of nurses found the current handoff note to be ineffective at preventing errors and 48% (N = 20/42) identified incomplete or missing information as a significant factor for ineffective communication. Other barriers identified included poor note design, lack of standardization in workflow and variation in note use. During the 1 week implementation of the new handoff tool, the utilization rate was 100% (N = 32) with completion rate of 41% (13 of 32). Further data collection is ongoing and nursing perception of the new tool will be evaluated at 3 months. Conclusions: Multidisciplinary stakeholders’ guided development and implementation of an EMR-integrated treatment handoff tool to optimize the communication between cancer care providers during patient transition is associated with improvement in handoff tool utilization and communication.

MAKING PERIOPERATIVE HANDOFF COMMUNICATION COUNT BY IMPROVING SAFETY AND QUALITY IN A NEW CONGENITAL HEART PROGRAM

Background: Coordination among units, staff and equipment for a congenital cardiac surgical patient requires a strategic process. Structured handoff processes enhance teamwork, communication and patient outcomes. Transitioning patients from the operating room (OR) to the congenital cardiac intensive

A Handoffs Software Led to Fewer Errors of Omission and Better Provider Satisfaction: A Randomized Control Trial.

Computer-assisted communication is shown to prevent critical omissions ("errors") in the handoff process. The aim of the study was to study this effect and related provider satisfaction, using a standardized software. Fourteen internal medicine house officers staffed 6 days and 1 cross-covering teams were randomized to either the intervention group or control, employing usual handoff, so that handoff information was exchanged only between same-group subjects (daily, for 28 days). In the intervention group, fewer omissions (among those studied) occurred intravenous access (17 versus 422, P < 0.001), code status (1 versus 158, P < 0.001), diet/nothing per mouth (28 versus 477, P < 0.001), and deep venous thrombosis prophylaxis (17 versus 284, P < 0.001); duration to compose handoff was similar; and physicians perceived less workload adjusted for patient census and provider characteristics (P = 0.004) as well as better handoff quality (P < 0.001) and clarity (P < 0.001). The intervention was associated with fewer errors and superior provider satisfaction.

MRPL+: A mobility management framework in RPL/6LoWPAN

The next generation Internet (also known as Internet-of-Things – IoT), will ubiquitously integrate trillions of computing devices of all kinds, shapes and sizes. For this ubiquity to materialize, a key aspect will certainly be interoperability, the capability of different technologies (e.g. different communication protocols at both horizontal and vertical levels, different hardware platforms, different operating systems, fixed and mobile nodes, etc) to talk to and understand each other. A major enabler for this interoperability is the use of standard and commercial-off-the-shelf technologies (e.g. communication protocols, hardware platforms, operating systems). As IPv6 has become the de-facto communication technology for the Internet, 6LoWPAN has recently started paving the way for extending the Internet to low-power low-cost wireless devices. However, while mobility support will be a requirement (or at least beneficial) in many applications contexts, the support of mobile nodes in the default 6loWPAN/RPL protocol leads to excessive packet loss and delays.In this work, we show that interoperability between fixed and mobile nodes can be successfully achieved through the use of appropriate hand-off and topology management techniques. We propose a mobility management framework (dubbed mRPL+) unifying two hand-off models: (1) hard hand-off, where a mobile node has to break a link before finding a new link, and (2) soft hand-off, where a mobile node selects the new link before disconnecting from the current one. Importantly, mRPL+ is integrated in the 6LoWPAN/RPL stack in a backward compatible manner. Simulation results indicate that in a network with mobile nodes, packet delivery ratio with mRPL+ is nearly 100%, where RPL achieves 80% in best-case. Hand-off process has a disconnected period of few milliseconds (hand-off delay = 4 ms), while RPL experiences few seconds of disconnection during node’s mobility (3−10 s).

Secure and quality-of-service-supported service-oriented architecture for mobile cloud handoff process

Mobile Cloud Computing (MCC) combines the features of mobile computing, cloud computing, and wireless networks to create the healthy computational resources to mobile cloud users. The aim of MCC is to execute the highly attractive mobile applications on a plethora of mobile cellular telephones, with highly rich user experience. From the perspective of mobile computing, Quality of Service (QoS) provisioning depends on the efficiency of the handoff process. Thus, it is highly important to introduce an energy efficient and secure handoff process to improve the performance. In this paper, we propose a Secure Seamless Fast Handoff (SSFH) scheme to improve the energy efficiency and the QoS in the MCC. The proposed scheme consists of four layers: application layer, service layer, infrastructure layer, and media layer. These four layers collectively handle the security, energy-efficiency, and the QoS. Existing service-oriented architectures designed for the MCC are based on the symmetric encryption protocols to support the application layer. However, it is much easier for an adversary to expose the symmetric key and gain access to the confidential data. The application layer is secured using a combination of both attribute-based encryption and an asymmetric encryption cryptography. To extend the mobile lifetime, energy detection (ED) model is deployed at the infrastructure layer to detect the energy level of the mobile devices prior to the pre-registration process. Furthermore, a dual authentication process is performed on the service and at the application layer to minimize the possibility of identity-high jacked or impersonation attack. The media layer supports the secure handoff process using policy enforcement module that allows only legitimate users to complete the re-registration process after initiating the handoff. Thus, a significant amount of the bandwidth and energy could be preserved. Finally, the secure service-oriented architecture is programmed using C++ platform and the results are compared with other well-known existing service-oriented architectures. The experimental results confirm the validity and the effectiveness of our proposed architecture.

Approaches to Improving Nursing Handoffs in Surgical Wards

Objective: To propose approaches to improve nursing handoffs for surgical patients, including standardization. Background: Handoffs, or the transfer of accountability and patient information, can generate potential risks for patient safety. Standardization has been proposed to help improve handoffs. Methods: After observing 333 nursing handoffs in the surgical wards of our institution, we conducted a thematic content analysis, comparing and contrasting the observations. Results: Handoff processes, including the use of support tools, varied among the observations. Common themes in the handoff content suggested possibilities of standardization. About half of the 51 interruptions occurring during the observed handoffs were by healthcare professionals. Conclusions: Standardization to improve handoffs should address both the content and the process. Interruptions were common and should be avoided whenever possible. Future studies should also consider the use of mobile applications to support handoffs and clinical documentation.

PMNDN: Proxy Based Mobility Support Approach in Mobile NDN Environment

In this paper, we study the source mobility problem that exists in the current named data networking (NDN) architecture and propose a proxy-based mobility support approach named PMNDN to overcome the problem. PMNDN proposes using a proxy to efficiently manage source mobility. Besides, functionalities of the NDN access routers are extended to track the mobility status of a source and signal Proxy about a handoff event. With this design, a mobile source does not need to participate in handoff signaling which reduces the consumption of limited wireless bandwidth. PMNDN also features an ID that is structurally similar to the content name so that routing scalability of NDN architecture is maintained and addressing efficiency of Interest packets is improved. We illustrate the performance advantages of our proposed solution by comparing the handoff performance of the mobility support approaches with that in NDN architecture and current Internet architecture via analytical and simulation investigation. We show that PMNDN offers lower handoff cost, shorter handoff latency, and less packet losses during the handoff process.

Effectiveness of Handoff Educational Program on Nurses Interns’ Knowledge, and Communication Competence

With the growing complexity of health care, the ability to communicate becomes essential within the health team members. Health care organization has great expectations for new graduate nurses to communicate skillfully while promoting safe patient care. Student nurses interns may lacked experiences with important communication skills and are fearful of making mistakes which may affect patient safety. One way to improve handoff communication skill among nurses interns is through education. This study was intended to examine the effectiveness of handoff educational program on nurse’s interns’ handoff knowledge, and communication competence. Quasi - experimental study design was utilized: The study was conducted in intensive care units which affiliated with Kaser El Ainy hospital where nurses interns were trained. Study sample composed of 30 nurses interns who were undertaking their internship year between 2016-2017. Data were collected through utilizing Handoff knowledge questionnaire that was developed by the researcher and Handoff communication competence observational checklist developed by [1] and modified by the researchers to measure hand- off communication competence of nurses interns during the process of bedside handover. Results revealed that there were statistical significant and marked improvement in nurses interns’ levels of handoff knowledge dimensions as well as statistical significant differences in their mean scores of hand- off communication competence during different periods of assessment. The current study provide evidence that handoff educational program enhance nurses interns handoff communication competence. Handoff communication skills should taught formally during nursing academic education concerning the way that information is given, verified as well as all handoff communication competencies during process of patient bedside handoff. Future researches with larger sample sizes and multiple settings are recommended to substantially evaluate the effectiveness of educational program on handoff communication competencies.

A prediction-based handoff scheme for QoS in WLAN systems

In this paper, we introduce a technique to reduce the authentication overhead for handoff process in wireless local area networks (WLAN). It is based on user mobility prediction to reduce the network scanning area during the handoff procedure. The central server facilitates an intelligent mobility prediction mechanism to identify the next possible mobile access points for mobile subscriber. The predicted information is managed by an event log table, and it helps to reduce the authorisation overheads for cellular networks. It follows the reserve channel scheme to maintain the QoS for users during the call and handoff procedure and the handover-call has higher priority over local initiated call. The analytical model shows the effectiveness and efficiency of proposed work, we apply the Markov random walk model and M/M/1 queuing model to formulate our work. It is compared with the tradition technique, and has 40% better result than legacy techniques.

A QI initiative: implementing a patient handoff checklist for pediatric hospitalist attendings

Handoffs represent a critical transition point in patient care that play a key role in patient safety. Our quality improvement project was a descriptive observational study aimed at standardizing pediatric...