SFGH Patient Handoff System

Each year, approximately 180 residents rotate through the Department of Medicine at San Francisco General Hospital, servicing over 3700 patients and generating over 60 records each day for the patient handoff procedure that residents carry out during shift change. The current procedure relies on each resident manually transcribing and entering data for every patient (e.g., name, MRN, location, medications, lab results), updating the data daily, and verbally communicating action items and anticipated problems to the other residents. This process is bad for patient care,^1,2,3 and increases the liability of the institution and involved individuals of having to spend significant time and effort responding to regulatory agencies as well as incurring significant monetary penalties. We propose designing an electronic handoff system accessible by any client with a web browser or as a printed and de-identified form, and updated by the hospital ADT HL7 feed, as mitigation for these problems and to replace the current patient handoff process and system.

The EMR used at SFGH (Invision) does not have patient handoff functionality. The current system for tracking handoffs is a twelve year old FileMaker database that can only be accessed by a full installation of FileMaker 6. Space for computers/COWS/laptops at SFGH is at a premium, and the diverse and modern nature of the DOM requires a modern solution.

Specifically, this project expects to improve communication between clinicians in the DOM (with pre- and post-surveys); decrease the number of reportable events compared year-over-year by printing de-identified notes and making an electronic version available; and provide a stable, long-term solution for the patient handoff process that works with any modern client endpoint. The new system would improve patient safety by pulling information from the hospital ADT HL7 feed, thereby reducing the need for data transcription and the errors it introduces. If this project is successful, we hope it will be evaluated as a possible solution for other services and clinics at SFGH.

The project’s requirements include an encrypted SQL database on DPH networks; an HTTPS server on DPH networks, and the SFGH ADT HL7 feed.

Deliverables

A web application that: is hosted in the DPH data center at SFGH; authenticates users against the DPH Active Directory; provides residents with an electronic handoff solution to replace the existing FileMaker solution; provides access to the handoff system on mobile devices; provides de-identified forms to print for carrying on the person.

Impact on UCSF’s Mission and/or Community

The most visible impact will be a decrease in the number of reportable events. A system that prevents one event will pay for the cost of this project. We hope to improve patient care and the current workflow of DOM residents, and provide a platform that can support other departments and clinics with similar patient care issues. This application will improve the care provided to vulnerable populations of patients not often seen by the rest of the UCSF community at the city’s only public hospital.

List of Team Members and their Roles (Estimated Time in Hours)

Michael Hodges, SFGH Dean’s Office; Project/infrastructure coordinator; DPH IT liaison; (250 hours)
Richard Brooks, MD, MPH, SFGH DOM; Faculty sponsor; DOM liaison; subject matter expert; migration coordinator; tester; (40 hours)
_____________, UCSF; Lead designer; lead web developer; DBA; (200 hours)
_____________, UCSF; HL7 parser developer; web developer; DBA; (120 hours)

¹ Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events; http://www.ncbi.nlm.nih.gov/pubmed/9547682
² Improving physician communication through an automated, integrated sign-out system; http://www.ncbi.nlm.nih.gov/pubmed/16266035
³ Creating Resilient IT: How the Sign-Out Sheet Shows Clinicians Make Healthcare Work; http://www.ncbi.nlm.nih.gov/pubmed/17238408