Improving Patient Flow From the Emergency Department Utilizing a Standardized Electronic Nursing Handoff Process

Area of Science:

• Healthcare Management
• Patient Flow Optimization
• Nursing Informatics

Background:

• Emergency Department (ED) boarding negatively impacts patient care quality, safety, and experience.
• Inadequate standardized and transparent handoff communication is a key factor contributing to ED boarding.
• A process improvement initiative was launched to address these issues.

Purpose of the Study:

• To decrease handoff delays from the ED, measured by ready-to-move (RTM)-to-occupied time.
• To evaluate the impact of a standardized electronic handoff process on patient flow.
• To improve the efficiency of bed management within the hospital.

Main Methods:

• Implementation of a standardized electronic situation, background, assessment, and recommendation (eSBAR) format for nursing handoffs from the ED to medical units.
• Face-to-face education of nursing staff on the initiative's background, significance, and process.
• Measurement of RTM-to-occupied times before and after the eSBAR implementation.

Main Results:

• The house-wide average RTM-to-occupied time decreased from 83.6 minutes before implementation to 49 minutes at 3 weeks post-implementation, representing a 41.4% reduction.
• Further improvement was observed, with the average time decreasing to 47 minutes at 10 months post-implementation.
• No adverse patient safety or quality issues were identified in relation to the new handoff process.

Conclusions:

• The adoption of an electronic, standardized nursing handoff process effectively reduced ED boarding times.
• This initiative led to increased bed flow efficiency within the hospital.
• Standardized communication protocols are crucial for optimizing patient flow and care delivery.