Telemedicine for Interfacility Nurse Handoffs

Monica K. Lieng, Heather M. Siefkes, Jennifer Rosenthal, Hadley S. Sauers-Ford, Jamie L. Mouzoon, Ilana S. Sigal, Parul Dayal, Shelby T. Chen, Cheryl L. McBeth, Sandie Dial, Genevieve Dizon, Haley E. Dannewitz, Kiersten Kozycz, Torryn L. Jennings-Hill, Jennifer M. Martinson, Julia K. Huerta, Emily A. Pons, Nicole Vance, Breanna N. Warnock, James P Marcin

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING: Tertiary PICU within an academic children's hospital. PARTICIPANTS: PICU nurses who received a patient handoff between October 2017 and July 2018.None. MAIN RESULTS AND MEASUREMENTS: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

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Telemedicine
Nurses
Patient Handoff
Telephone
Pediatrics
Multilevel Analysis
Mortality
Electronic Health Records
Insurance
Critical Illness
Cluster Analysis
Hospital Emergency Service
Language
Cross-Sectional Studies
Communication
Exercise

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Telemedicine for Interfacility Nurse Handoffs. / Lieng, Monica K.; Siefkes, Heather M.; Rosenthal, Jennifer; Sauers-Ford, Hadley S.; Mouzoon, Jamie L.; Sigal, Ilana S.; Dayal, Parul; Chen, Shelby T.; McBeth, Cheryl L.; Dial, Sandie; Dizon, Genevieve; Dannewitz, Haley E.; Kozycz, Kiersten; Jennings-Hill, Torryn L.; Martinson, Jennifer M.; Huerta, Julia K.; Pons, Emily A.; Vance, Nicole; Warnock, Breanna N.; Marcin, James P.

In: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, Vol. 20, No. 9, 01.09.2019, p. 832-840.

Research output: Contribution to journalArticle

Lieng, MK, Siefkes, HM, Rosenthal, J, Sauers-Ford, HS, Mouzoon, JL, Sigal, IS, Dayal, P, Chen, ST, McBeth, CL, Dial, S, Dizon, G, Dannewitz, HE, Kozycz, K, Jennings-Hill, TL, Martinson, JM, Huerta, JK, Pons, EA, Vance, N, Warnock, BN & Marcin, JP 2019, 'Telemedicine for Interfacility Nurse Handoffs', Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 20, no. 9, pp. 832-840. https://doi.org/10.1097/PCC.0000000000002011
Lieng, Monica K. ; Siefkes, Heather M. ; Rosenthal, Jennifer ; Sauers-Ford, Hadley S. ; Mouzoon, Jamie L. ; Sigal, Ilana S. ; Dayal, Parul ; Chen, Shelby T. ; McBeth, Cheryl L. ; Dial, Sandie ; Dizon, Genevieve ; Dannewitz, Haley E. ; Kozycz, Kiersten ; Jennings-Hill, Torryn L. ; Martinson, Jennifer M. ; Huerta, Julia K. ; Pons, Emily A. ; Vance, Nicole ; Warnock, Breanna N. ; Marcin, James P. / Telemedicine for Interfacility Nurse Handoffs. In: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2019 ; Vol. 20, No. 9. pp. 832-840.
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abstract = "OBJECTIVE: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING: Tertiary PICU within an academic children's hospital. PARTICIPANTS: PICU nurses who received a patient handoff between October 2017 and July 2018.None. MAIN RESULTS AND MEASUREMENTS: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44{\%} survey response rate). Telemedicine was used for 30 handoffs (28{\%}), and telephone was used for 76 handoffs (72{\%}). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.",
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T1 - Telemedicine for Interfacility Nurse Handoffs

AU - Lieng, Monica K.

AU - Siefkes, Heather M.

AU - Rosenthal, Jennifer

AU - Sauers-Ford, Hadley S.

AU - Mouzoon, Jamie L.

AU - Sigal, Ilana S.

AU - Dayal, Parul

AU - Chen, Shelby T.

AU - McBeth, Cheryl L.

AU - Dial, Sandie

AU - Dizon, Genevieve

AU - Dannewitz, Haley E.

AU - Kozycz, Kiersten

AU - Jennings-Hill, Torryn L.

AU - Martinson, Jennifer M.

AU - Huerta, Julia K.

AU - Pons, Emily A.

AU - Vance, Nicole

AU - Warnock, Breanna N.

AU - Marcin, James P

PY - 2019/9/1

Y1 - 2019/9/1

N2 - OBJECTIVE: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING: Tertiary PICU within an academic children's hospital. PARTICIPANTS: PICU nurses who received a patient handoff between October 2017 and July 2018.None. MAIN RESULTS AND MEASUREMENTS: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

AB - OBJECTIVE: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING: Tertiary PICU within an academic children's hospital. PARTICIPANTS: PICU nurses who received a patient handoff between October 2017 and July 2018.None. MAIN RESULTS AND MEASUREMENTS: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

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