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  1. Alexander, Catherine DNP, MPH, RN
  2. Rovinski-Wagner, Christine MSN, APRN
  3. Wagner, Sandra BSN, RN
  4. Oliver, Brant J. PhD, MS, MPH, APRN-BC


Background: There is limited evidence available identifying best practices to promote and sustain optimal outpatient-to-inpatient handoff processes to ensure safe and reliable continuity of care.


Local Problem: A sentinel event occurred during the transition of care from the outpatient-to-inpatient setting. A root cause analysis revealed that the facility's standard operating procedure for patient handoffs was not consistently followed.


Methods: A Lean Six Sigma approach was used to improve patient transfer with the implementation of a Situation-Background-Assessment-Recommendation handoff policy. Inferential and statistical process control methods were used to assess performance outcomes pre- and postdissemination.


Results: Over 36 months there was a slow, steady decrease in patient transfer time including reduced variability. The most significant improvement effect occurred in the third year with a 50% reduction in transfer time.


Conclusions: Longitudinal monitoring provides the opportunity to accurately identify beneficial outcomes, which develop downstream from initial quality improvement efforts.