Emerging Issues with the VA Shift Handoff Tool

• 1/14/2010
• Author: Steven Berman
• Category: The Journal Blog
• 16407 Views
• 0 Comments
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This week, Peter Kaboli, the senior author of “The Veterans Affairs Shift Change Physician-to-Physician Handoff Project,” which appears in the February 2010 issue, guests on the Journal blog. The development team designed an electronic medical record (EMR) handoff tool to provide a standardized approach to handoff communications and improve on previous handoff methods. As Dr. Kaboli and his co-authors noted in the article, a final version of the software was incorporated into the national EMR software program and made available to all Department of Veterans Affairs medical centers in June 2008. Dr. Kaboli takes this opportunity to reflect on some of the issues that have emerged since the rollout. The Journal welcomes your comments.

The VA Shift Handoff Tool became available to all VAMCs in June 2008 as a new function to the VA Computerized Patient Record System (CPRS). The rollout included notices by email, listserves, and other updates at all 129 VAMCs. There have been no formal surveys of adoption, so all reports have been anecdotal to the development team. A number of observations have been made:

• • More widespread adoption by medicine than surgery or psychiatry services.  The reason for this is unclear. However, one VAMC surgery program, which did not feel that the automatic fields met their requirements, preferred to have residents continue to enter information into a spreadsheet. 
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• • Medicine services that adopted the Shift Handoff Tool have used it for both housestaff and staff attendings (especially hospitalists) for their handoff communication. By report, after the tool was adopted it has been continuously used. One minor recommended modification was to move the “code status” line into another box to allow another column for free text. However, program modifications are difficult to request, and the development team was told that it was not a priority at this time.  
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• • In the past 2 months, one significant problem developed in at least 7 VAMCs.  The program works properly, but when the physician sends the tool to the printer, it prints out 50 blank pages. Because covering physicians need a paper copy to carry with them, they had to return to their prior system, which in turn highlighted how valuable the Shift Handoff Tool had become. The programming team is working on the problem and hopes to have it corrected soon.  
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The next step in the tool’s continual development is to better understand how it can be integrated with nursing change-of-shift.  Because handoff communication between providers is not part of the medical record, nurses do not have access to this information. However, there are obvious reasons why nurses would want to know what physicians are signing-out to each other.  Likewise, there is important information that nurses sign-out to one another that would be important for physicians. Ongoing work at the Iowa City VAMC and VA National Patient Safety Center in Ann Arbor is exploring how to optimally integrate the flow of information between nurses and physicians using an EMR.