Caroline Helwick

October 24, 2012

NEW ORLEANS — By identifying shared priorities and key elements in newborn "handoffs," a team of community pediatric hospitalists were able to improve the quality of this transition and reduce the time involved.

At the American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition, Alexander M. Hamling, MD, MBA, of Seattle Children's Hospital and the University of Washington, described efforts to simplify and streamline this twice-daily process at 2 regional hospitals.

"Verbal handoffs from one pediatric hospitalist to another are a common practice between shifts. There is inherent inconsistency when 9 physicians conduct their own style of handoffs each morning," Dr. Hamling said.

"Before our intervention, we were hitting only about 50% of the key elements that physicians need to hear for safe newborn handoff, but after the intervention, we saw a dramatic increase in virtually all elements," he reported.

Physicians Determined Their Own Key Elements

Dr. Hamling initiated the quality improvement process by first determining the baseline performance via voice recordings of each handoff — in other words, how well physicians communicated the essential information during each handoff.

"I...gave every physician a digital voice recorder and asked them to press the record button during each handoff episode," he said. These recordings constituted the preintervention measurement.

To develop a standardized approach, members of the team answered a 22-element questionnaire, which asked, "What independent key elements about a newborn's birth history and hospital course would you like to specifically know for a safe transfer of care?" Elements requested by more than one half of the group were compiled into a handoff template and were characterized as the key elements that should be covered in every handoff.

These elements of communication and safety were presented and reinforced during staff meetings, and team members were again tape-recorded to capture their postintervention practices.

Eight key elements were identified: last name of infant; sex; gestational age category; weight compared with gestational age; method of delivery; maternal group B streptococcal (GBS) status; maternal blood type; and expected day for discharge.

The intervention was very successful in improving the quality of the handoffs, Dr. Hamling reported.

Prior to the standardized protocol, key elements were discussed during 40% of the handoffs (range, 0 to 74%). After creation of the handoff template and feedback to the physicians, the average rose to 84% (range, 23% to 99%) (P = .006).

"Seven of the 8 key elements showed statistically significant improvement," he stated.

For example, use of maternal GBS status in the handoff discussion increased from 42% to 93% (P < .05). "We anticipate that this will lead to improved decision-making on length of stay, laboratory screening, and treatment options that are consistent with guidelines," he said.

The improvement seen in communication of the maternal blood type, from 2% to 81% (P < .05), may lead to increased surveillance of ABO incompatibility, he added.

"We also saw a decrease in the time the handoff takes," he added. Time per handoff per newborn was 57 seconds at baseline and 51 seconds after the intervention.

"While this was not statistically significant, the trend demonstrates less time needed for a complete and valuable handoff of a newborn patient. We do 15 to 20 newborn handoffs each morning and evening, so this adds up to time saved," he pointed out. The new handoff template is now routinely in use at the hospitals.

Standardized Approach Will Preserve Critical Information

Daniel Rauch, MD, associate professor of pediatrics at Mount Sinai School of Medicine in New York City, moderated the Section on Hospital Medicine at the meeting and commented on the findings for Medscape Medical News.

"Physicians want to spend less time at the hospital these days, so we are more and more taking a team approach. If we are going to transfer information, we need to do so correctly," he said. "Loss of information during this process has been shown to negatively impact patient care. Good team communication is critical."

Dr. Rauch said other investigators are attempting to develop a standardized approach to newborn handoffs, recognizing that variability is detrimental.

"If your way isn't my way," he continued, "we are not talking the same language and we are losing information. We must be sure that critical information is passed on and understood by everyone from shift to shift."

Dr. Hamling and Dr. Rauch have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition. Abstract 16412. Presented October 20, 2012.