054 - Enhancing Handoff Processes in a Level IV NICU: A Quality Improvement Initiative

Publication Number: 54.4970

Kushal Y. Bhakta, CHOC Children's Hospital of Orange County/UC Irvine School of Medicine, Irvine, CA, United States; Kristin S. Fischer, CHOC Children's Hospital of Orange County, Rancho Santa Margarita, CA, United States; Jennie Sierra, CHOC Children's Hospital of Orange County, Laguna Niguel, CA, United States; Irfan Ahmad, CHOC Children's Hospital of Orange County, Tustin, CA, United States

Background: Effective handoff communication is crucial in Level IV Neonatal Intensive Care Units (NICUs) due to the high acuity and complexity of patient care. Inefficiencies in handoff can lead to information gaps, increased risk of errors, and compromised patient safety. Observations in our NICU revealed inconsistent handoff practices, prompting a need for a structured approach to standardize communication. To address these issues, we implemented the 5P handoff tool, focusing on Patient, Plan, Purpose, Problems, and Precautions, to improve information exchange and decrease variability in the handoff process.

Objective: The primary objective of this Quality Improvement (QI) initiative was to enhance the reliability and quality of handoffs in a busy Level IV NICU by adopting the 5P handoff tool. We aimed to improve clarity and reduce errors associated with communication lapses.

Design/Methods: The QI initiative followed the Model for Improvement framework, employing Plan-Do-Study-Act (PDSA) cycles to implement, assess, and refine the 5P handoff tool. Baseline data collection involved direct observations of handoffs, tracking completion of critical information. After staff training in the 5P tool, a 3 month pilot period allowed for testing its impact on handoff quality. Outcome metrics included the percentage of handoffs covering all 5P elements. Process metrics included the percentage of time the tool was utilized. Balancing metrics included the overall time of handoff per patient.

Results: Initial data post-implementation showed substantial improvements in handoff consistency. Observational assessments indicated a universal adoption of the tool, with up to 73% of handoffs covering all 5P elements. Compliance fell during high census/acuity periods. These findings suggest that the structured 5P tool provides a more reliable handoff process, improving information exchange in high-stress NICU settings.

Conclusion(s): The implementation of the 5P handoff tool demonstrates significant improvements in handoff reliability and clarity in a Level IV NICU. By standardizing communication around key patient details, the 5P tool minimized variability, promoting safer handoff practices. Future work will employ principles of planned experimentation to explore the impact of a designated handoff location, unit-wide notification of handoff times, and group versus individual team handoffs. This will help identify optimal conditions for sustaining high-quality handoffs and establish a model adaptable to other intensive care environments.

Outcome Measure
SPC chart showing the percentage of patients that had all components of the 5P handoff tool addressed during evening handoff. The special cause points below the Lower Control Limit (LCL) were all during periods of extreme high census.

Balancing Measure
SPC chart showing the average time spent per patient during each evening handoff session. During arrow indicates when the 5P handoff tool was officially launched. The average time spent per patient during handoff did not change from baseline, indicating that adoption of this tool did not lead a detrimental change in time spent.