title: Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit.
abstract: OBJECTIVE
  To evaluate the impact of integrating a handoff tool into the electronic medical record (EMR) on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit (NICU).
  
  
  METHODS
  Prospective surveys of neonatal care providers in an academic children's hospital 1 month before and 6 months following EMR integration of a standalone Microsoft Access neonatal handoff tool.
  
  
  RESULTS
  Providers perceived sign-out information to be somewhat or very accurate at a rate of 78% with the standalone handoff tool and 91% with the EMR-integrated tool (P < 0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration, 92% of providers were satisfied with the process of updating sign-out information (P < 0.01) and 98% were satisfied with the printed sign-out document (P<0.01). Neonatal care providers reported spending a median of 11 to 15 min/day updating the standalone sign-out and 16 to 20 min/day updating the EMR-integrated sign-out (P = 0.026). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P < 0.01).
  
  
  CONCLUSIONS
  Integration of a NICU-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and at least one aspect of workflow.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA. jpalma@lpch.org
authors.forename: J P
authors.initials: JP
authors.lastname: Palma
authors.forename: P J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: C A
authors.initials: CA
authors.lastname: Longhurst
mesh_terms: D001291:Attitude of Health Personnel; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D033183:Interdisciplinary Communication; D008490:Medical Informatics / Q000379:methods*; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards; D011446:Prospective Studies; D058996:Quality Improvement; D013192:Staff Development; D057188:Workflow