Standardizing transport handoff, a quality improvement, MOC initative

Background: Transport literature does not recognize a preferred handover method as best practice following interfacility transport. Yet, failures in communication from poor handover are associated with adverse patient events. The Joint Commission has prioritized standardizing transitions in care to improve safety and quality outcomes. Problem: In our hospital, transport handover varied depending on receiving unit, providers involved, and patient acuity. We sought to improve communication, teaming, and shared mental model development by standardizing interfacility transport handover between our critical care transport team and receiving units within our tertiary, pediatric referral center. Specific Aims: 1. Improve notification of patient arrival to receiving clinical providers to enhance attending physician presence at the time of arrival to 80% within 3 months. 2. Decrease distractions and interruptions during handover by 20% within 6 months. 3. Improve provider summarization and provision of anticipatory guidance by 20% within 6 months. Strategy/Implementation: We completed a quality improvement project by implementing PDSA cycles with tests of change for the specific aims described above. By incentivizing with MOC credit, 81% of the NICU, PICU, CVICU, and ED physicians participated in this project. Baseline data was collected using questionnaires distributed after transport handover. Additionally, the transport team collected data on staff presence, arrival times, environmental data, interruptions, behaviors of participants, and handover content. Initial data revealed attending presence at 70% of the handovers had distracting interruptions. PDSA cycles were completed quarterly for 12 months. In PDSA cycle #1, we developed an institution-wide standardized handoff template (Figure 1) and created a video for physician and transport education. Nurses and RTs were educated at staff meetings and via email. Notification of transport arrival was initiated by the transfer center. In cycle #2, physicians were re-educated on summarization, providing a care plan and anticipatory guidance. The staff was empowered to speak up if the room was not quiet or distractions were noted during handoff, and there was additional education on the notification call tree. During cycle #3, we educated the residents to participate in standardized handoff and asked the faculty to supervise. PDSA cycle #4 tested sustainability. Results: Standardized