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

Potts, Lisa, DNP, RN; Ryan, Catherine, PhD, APN, CCRN-K, FAHA, FAAN; Diegel-Vacek, Lauren, DNP, APN, FNP-BC; Murchek, Alisa, DNP, RN, CEN, NEA-BC

JONA: The Journal of Nursing Administration: September 2018 - Volume 48 - Issue 9 - p 432–436
doi: 10.1097/NNA.0000000000000645

OBJECTIVE The goal of this project was to decrease handoff delays from the emergency department (ED) as measured by ready to move (RTM)–to–occupied time.

BACKGROUND ED boarding compromises the quality, safety, and experience of patient care. Lack of standardized and transparent handoff communication contributes to boarding time. This process improvement initiative implemented a standardized electronic situation, background, assessment, and recommendation (eSBAR) format-based nursing handoff process from the ED to a medical unit.

METHODS Nursing staff were educated face-to-face regarding the initiative background, significance, and process. Outcomes were measured before and after eSBAR implementation.

RESULTS Before implementation, the house-wide average RTM-to-occupied time was 83.6 minutes. This decreased to 49 minutes (a 41.4% decrease) 3 weeks after implementation and improved further to 47 minutes at 10 months after implementation. No related patient safety or quality issues were identified.

CONCLUSIONS The use of an electronic, standardized handoff communication process resulted in decreased boarding time and increased bed flow efficiency.

Author Affiliations: Senior Director of Patient Care Services and Interim Associate Chief Nursing Officer (Dr Potts), University of Illinois Hospital & Health Sciences System; Clinical Associate Professor (Dr Ryan) and Clinical Assistant Professor (Dr Diegel-Vacek), University of Illinois at Chicago College of Nursing Department of Biobehavioral Health Sciences; and Director (Dr Ryan), Evidence-Based Practice, University of Illinois Hospital, Chicago; and Vice President of Patient Services and Chief Nursing Officer (Dr Murchek), Franciscan Health Hammond, Indiana.

The authors declare no conflicts of interest.

Correspondence: Dr Potts, University of Illinois Hospital, 1740 W Taylor St, Chicago, IL 60612 (

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