Implementation of a Novel iOS Application to Improve Patient Handoffs

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Shift changes are complex and present opportunities for error. At Duke University, inpatient services have a pager number that must be linked to a specific resident's pager, requiring seven phone calls and 168 keystrokes. A single error can prevent communication between nursing staff and residents. An application for iOS was released January 2015, reducing the total keystrokes to seven.


An anonymous survey was sent to all residents who had the application available to them. Phone records were reviewed for handoff errors before and after implementation of the application. Each transition of care was evaluated for timely re-assignment of pagers.


Twenty-five of 38 residents (66%) responded to the survey. Ninety percent of respondents had an iOS compatible device and 40% installed the application. Eighty percent of those with it installed used the application, and 100% of users felt it reduced errors. Two hundred total handoff events were evaluated. Pre-implementation there was a 29.9% error rate, with the application available the error rate was 31.6%.


A mobile application to improve patient care handoffs was not widely used despite high levels of software compatibility. There was no improvement in error rates of pager assignments in our preliminary evaluation, however residents using the application felt it reduced errors. This study demonstrates the difficulty in implementing technology-based tools to reduce errors in handoffs, in both utilization rates and predicting efficacy. Future development efforts should consider these issues.

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