Implementation and Analysis of an Institution-Wide EHR-Integrated Handoff Note.

EHR-Integrated Handoff Notes are becoming increasingly prevalent, especially among inpatient clinical service teams composed of physicians in training (resident physicians). We describe the implementation of such a tool at our institution, and then describe the usage of the tool, as well as changes made to its content, structure, and format, years after original implementation. We also describe frequency and temporal distribution of updates made to free text elements of the Handoff Note. At the initial implementation there were three versions available; medical/surgical, pediatric, and ICU. Years after implementation, 57% of clinical service teams continue to utilize the note, including all medical, pediatric, behavioral health, obstetrics/gynecology, and neurology services, as well as most surgical services, that serve as "primary" teams. Several interesting changes were noted to the content and structure of the Handoff Note, namely that more complicated versions were abandoned in favor of simpler versions. The Patient Summary and To Do free text boxes are updated an average of 1.0 and 1.6 times per day. Around 60% of updates to both free text boxes occur between 12 pm - 5:59 pm, likely in preparation for the daytime-nightime team handoff.

Resident-Physician Preferences for Electronic Handoff Note Content: Implications for Implementation of a System-Wide Electronic Health Record-Integrated Handoff Tool.

Increasing attention is paid to the Handoff Process and EHR- integrated tools to enhance the Handoff Process and aid in creating Handoff Notes are becoming more prevalent. In this study, we attempted to determine the ideal content of the Handoff Note based on the preferences of the resident physicians for whom the tool was being constructed. This commenced with an initial semi-structured interview and culminated in a large-scale survey. Overall, 315 resident physicians completed the survey. Plan of Care, Illness Severity, and Patient Summary were the most important content elements to resident physicians. The importance and trustworthiness of other content elements, as well as their preferred display and level of granularity within the Handoff Note, varied considerably. Subjective assessment by a colleague of a patient's hospital course and plan of care, rather than any single piece of objective data, are preferred as ideal content for Handoff Note composition by resident physicians.