Date of Award

Summer 2026

Abstract

Abstract

Background: Effective care handoff is a necessary step for maintaining patient safety during hospitalizations. The goal of this quality improvement project was to improve the completeness of information, particularly cardiac-related, provided by the ED staff to the CSSU nurses. The implementation involved the creation of a cardiac checklist and applying it to the pre-existing I-PASS forms used during asynchronous handoff.

Local Problem: The macrosystem implemented an updated system for handoffs between the ED and CSSU by substituting an over-the-phone report with a faxed I-PASS sheet. The result, as identified by the CSSU staff, is that reports contain undetailed patient histories, incomplete medication lists, and no opportunities for questions, leaving knowledge gaps unaddressed.

Methods: This quality improvement project was conducted in a 15-bed CSSU located within a level II trauma center in New Hampshire. The pre- and post- staff satisfaction surveys utilized the Qualtrics™ online survey platform and were distributed among microsystem nurses. The surveys contained nine Likert-scale items, which contributed to quantitative results and were analyzed for the mean, percent change, total change, and range. Results from open-ended questions contributed to the qualitative results and the creation of the cardiac checklist intervention.

Results: A key finding of this quality improvement project was, before the intervention, nurses reported dissatisfaction with the existing asynchronous I-PASS handoff process. The specific information noted by staff to be missing from the current handoff sheet and that was then applied to the cardiac checklist was intravenous drip medications, EKG results, history of cardiac-related disease, rhythm on telemetry, and pacemaker information. After the creation of the cardiac checklist, survey responses indicated an increase in satisfaction with the handoff, with some Likert values more than doubling. Staff indicated that the updated I-PASS sheet provided complete patient information, provided important cardiac information, facilitated a smooth transition of care, and that they were satisfied with this handoff tool.

Conclusion: The results of this quality improvement project support both the global and specific aims. Overall, the creation of an intervention using staff feedback and avoiding significant workflow changes was associated with increased staff satisfaction. This quality improvement project has usefulness for the macrosystem's cardiac stepdown unit and emergency department for improved asynchronous handoff communication.

Document Type

Master's Thesis

First Advisor

Elizabeth Evans

Second Advisor

Pamela Kallmerten

College or School

CHHS

Department or Program

Direct Entry Master's in Nursing (DEMN)

Degree Name

Master of Science

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