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Handoff Techniques- Benefits of SBAR. Overview. What is a Handoff? Types of Handoff? Problems with Handoffs? Techniques for Communication Why is efficient communication important? Why SBAR? SBAR Methodology SBAR Example Case Studies Key Findings/Results Result 1 Result 2
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Overview • What is a Handoff? • Types of Handoff? • Problems with Handoffs? • Techniques for Communication • Why is efficient communication important? • Why SBAR? • SBAR Methodology • SBAR Example • Case Studies • Key Findings/Results • Result 1 • Result 2 • How does SBAR improve communication? • Tips for Handoff • Conclusion • Q&A
What is a Handoff? Source: Runy, L. (2008). H&HN: Hospitals & Health Networks, 82(5), 41.
Types of Handoff? Source: Runy, L. (2008). H&HN: Hospitals & Health Networks, 82(5), 41.
Problems with Handoffs • Contemporary Healthcare systems are more complex than those from previous generations • Hierarchies within an organization prevent efficient communication • Specialization leads to dispersion of the care process
Techniques for Communication • Audiotapes • Forms and Checklists • I PASS the BATON • SBAR • SBAR+2
Why is efficient communication important? Statistics The Institute of Medicine (1999) has estimated that as many as 98,000 people die in US hospitals each year due to preventable medical errors. The Joint Commission (2004) reports that 72 percent of root causes identified during the reviews of sentinel events related to infant death and injury during delivery are attributable to communication failures. As a result, the Join commission (2008) has identified effective communication as one of its National Patient Safety Goals. • Communication patterns between clinicians can vary depending upon clinician gender, education level, cultural background, past personal experiences, stress, environmental distractions, and individual communication style. • Poor communication between clinicians has been linked with sentinel events (i.e., an unanticipated patient safety incident that results in death or severe injury or the risk of death or injury). In the acute care setting, risk for communication failure is increased due to noise and other environmental distractions.
Why SBAR? • SBAR answers these questions: • What is it? • What do you need me to do? • When do I have to do it? • Using a standardized framework such as the SBAR technique can eliminate communication failure due to differences in communication patterns between clinicians • Use of standardized communication methods like the SBAR technique can help streamline information and ensure that key patient information (e.g., urgent medications or treatments and important assessment findings) is shared clearly and efficiently
SBAR Methodology • SBAR technique • Situation Patient Identification information, code status, vitals and concerns • Background This includes the context and objective data • Assessment Identifies the problem • Recommendation Includes follow-up action and possible tests
Handoff Procedure-Case Study • Background Lori Olvera (labor and delivery nurse) and Mary Campbell(perinatal clinical nurse) are employed at a regional tertiary medical center with approximately 5,500 births per year. The majority of births are considered low-risk and deliver at term. The nurses explain about their hospital and how there was discontent and tension between their teams. They report that each nurse cares for three to four mother baby couplets, making coordination of unit-to-unit report a very complex problem. The staff concurrently agreed that the current process was not optimal for patient care and safety, and there was a potential for safety hazards due to lack of “in person” reporting. • Envisioning Change The staff councils put together a task force to solve this problem. The most common barriers they faced were time constraints, resistance to change and utilization of the hospital’s t-tracking system to track patient delivery and transfer time. • Implementing Change All staff were trained in the process before implementation. L&D nurses learned to use the computer patient tracking system for delivery and transfer time. Everyone was trained to use the new SBAR report forms. Most importantly, the committee members and management team educated staff and promoted and reinforced the new process.
Handoff Procedure-Case Study Patient Benefits Staff Benefits • Report was now done in private with minimal • By meeting their new care giver in a safe L&D environment patients were easily transferred to the MNB nurse. • Family participation increased • MNB nurse benefited from the joint review of relevant patient history information • The L&D nurse benefited from knowing that she had given direct report to the appropriate nurse and would not need to answer questions or correct errors post transport.
Improving Handoff in the ED- Case Study Methodist Hospital • At Methodist Hospital, a new SBAR process to assist in the patient handoff process. The new process extracted the patient information form the electronic medical records using SBAR methodology and sent that information directly to the receiving units printer. The nurse or unit clerk calls to verify the receipt and as whether there are any questions. • Prior to this process, transfer of information was primarily done via the phone.
I PASS the BATON and SBAR-Case Study Trinity Medical Centre • Trinity Medical Center combined two communications techniques: SBAR and 1 PASS the BATON. SBAR was already used in the organization to enhance communications between nurses and physicians. To facilitate handoffs, nurses now keep brief, up-to-date forms on patients using the SBAR format. • These forms, which are not part of the patient's medical record, are copied and placed in a plastic baton and transported along with the patient. For example, before use of the forms when patients were transported to radiology, clinicians would have to review the entire medical record to find the information they needed. The forms save time because they provide quick access to important information. The forms include a place for specialty areas to add information and a contact number for the outgoing caregiver.
How does SBAR improve communication? • Reducing patient safety errors related to communication • Providing clinicians with a script to follow when communicating so that crucial patient information is conveyed • Allowing for the sharing of information in an easy to follow and logical sequence • Making communication more efficient • Reducing confusion resulting from differences in clinician communication patterns • Standardizing communication in accordance with TJC and IHI standards • Easy to integrate into daily communication
Conclusion • Through the help of this presentation we have understood handoff procedures and why communication is an important area to focus on. • We have studied handoff technique, primarily SBAR, and discussed where the process has been implemented to success. • Finally, we discussed how SBAR improves communication and tips for efficient implementation.
