Date of Doctor of Nursing Practice Project Completion
Winter 12-10-2025
Faculty Advisor
Dr. Mahrokh Kobeissi
Abstract
Purpose
The Quality Improvement (QI) project aimed to implement an electronic health record (EHR)-based SMART phrase handoff tool to improve patient safety outcomes, such as reducing Clinical Emergency Response Team (CERT) activations by 20% during dialysis treatments, minimizing treatment delays, and decreasing communication errors during care transitions.
Background
The lack of a standardized handoff process led to adverse patient events and prolonged hospital stay. Joint Commission identifies communication failures as a leading cause of sentinel events and recommends using structured handoff tools.
Methodology
The project was implemented at a dialysis unit at Texas Medical Center, Houston. A SBAR (Situation, Background, Assessment, and Recommendation)-based SMART phrase handoff template was integrated into the EHR under “dialysis handoff,” capturing diagnosis, dialysis access, labs, vital signs, and safety (yes/no) questions. Dialysis nurses confirmed the patient’s pre-transport readiness with the sending nurse using EPIC secure chat. Staff compliance was audited weekly; staff feedback and recommendations were integrated into the “dialysis handoff” using the Plan-Do-Study-Act cycle.
Results
The QI project resulted in a significant decline in CERT events, from 16 in Quarter 3 to 3 in Quarter 4 in 2025 (a 75% decline). Staff’s adherence to the handoff process improved from 60 to 90% during the implementation period; staff satisfaction survey noted reduced uncertainty, and smoother transition of patients to and from the dialysis unit.
Implications
The EHR-integrated handoff tool significantly improved patient safety outcomes and staff compliance, highlighting the value of standardized communication in care transitions. Sustainability efforts should include ongoing training for new orientees and expanding workflows to additional units.
Keywords
Key words: EHR-integrated handoff tool, handoff, patient safety outcomes, PDSA cycle
Recommended Citation
Jolly Mathews, "Implementing an EHR Handoff Tool to Improve Care Transitions for Patients Requiring Inpatient Dialysis" (2025). Doctor of Nursing Practice Final Project Abstract. 151.
https://digitalcommons.library.tmc.edu/dnp_abstract/151