ArticlesBuilding a Reliable Health Care System A Lean Six Sigma Quality Improvement Initiative on Patient HandoffAlexander, Catherine DNP, MPH, RN; Rovinski-Wagner, Christine MSN, APRN; Wagner, Sandra BSN, RN; Oliver, Brant J. PhD, MS, MPH, APRN-BCAuthor Information Department of Community & Family Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire (Dr Alexander); Office of Veterans Access to Care, Veterans Health Administration, Washington, District of Columbia (Ms Rovinski-Wagner); VA Quality Scholars Fellowship Program, White River Junction VA Medical Center, Vermont (Ms Rovinski-Wagner and Dr Oliver); Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Ms Rovinski-Wagner); White River Junction VA Medical Center, Vermont (Ms Wagner); and Departments of Community & Family Medicine and Psychiatry, and the Dartmouth Institute Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Dr Oliver). Correspondence: Catherine Alexander, DNP, MPH, RN, Department of Community & Family Medicine, Dartmouth-Hitchcock, 1 Medical Center Dr, Lebanon, NH 03766 ([email protected]). This work was supported by the VA Quality Scholars (VAQS) fellowship program funded through the VA Office of Academic Affiliations, Department of Veterans Affairs, Veterans Health Administration. Dr Alexander was supported as a VAQS postdoctoral fellow and Ms Rovinski-Wagner and Dr Oliver were supported as VAQS faculty supervising Dr Alexander during the time that this work was conducted. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jncqjournal.com). Accepted for publication: August 11, 2020 Published ahead of print: September 14, 2020 Journal of Nursing Care Quality: July/September 2021 - Volume 36 - Issue 3 - p 195-201 doi: 10.1097/NCQ.0000000000000519 Buy SDC Metrics Abstract Background: There is limited evidence available identifying best practices to promote and sustain optimal outpatient-to-inpatient handoff processes to ensure safe and reliable continuity of care. Local Problem: A sentinel event occurred during the transition of care from the outpatient-to-inpatient setting. A root cause analysis revealed that the facility's standard operating procedure for patient handoffs was not consistently followed. Methods: A Lean Six Sigma approach was used to improve patient transfer with the implementation of a Situation-Background-Assessment-Recommendation handoff policy. Inferential and statistical process control methods were used to assess performance outcomes pre- and postdissemination. Results: Over 36 months there was a slow, steady decrease in patient transfer time including reduced variability. The most significant improvement effect occurred in the third year with a 50% reduction in transfer time. Conclusions: Longitudinal monitoring provides the opportunity to accurately identify beneficial outcomes, which develop downstream from initial quality improvement efforts. © 2020 Wolters Kluwer Health, Inc. All rights reserved.