127 - Improving the Workflow of the Newborn Nursery

Publication Number: 3121.127

Miral Mehyar, University of Texas Medical Branch School of Medicine, Texas City, TX, United States; Neel Patel, University of Texas Medical Branch at Galveston, League City, TX, United States; Nancy Trinh, University of Texas Medical Branch School of Medicine, Galveston, TX, United States; Anoop Chandran, University of Texas Medical Branch School of Medicine, GALVESTON, TX, United States; Aimee Lopez, University of Texas Medical Branch School of Medicine, Pearland, TX, United States; Saher Fatima, University of Texas Medical Branch, sugar land, TX, United States; Sara Sadiq, University of Texas Medical Branch School of Medicine, Galveston, TX, United States; Sofia Jares Baglivo, UTMB, Galveston, TX, United States; Abdulrahman Alhanbali, University of Texas Medical Branch School of Medicine, Galveston, TX, United States; Mariam Siddiqi, University of Texas Medical Branch School of Medicine, League City, TX, United States; Amir N. Mubarak, University of Texas Medical Branch School of Medicine, Galveston, TX, United States; Muhammad Zaid H. Hussain, University of Texas Medical Branch School of Medicine, Houston, TX, United States; Abdallah Alkhaldi, University of Texas Medical Branch School of Medicine, Galveston, TX, United States; Elizabeth Rodriguez Lien, University of Texas Medical Branch School of Medicine, Galveston, TX, United States; Maria E.. Franco Fuenmayor, University of Texas Medical Branch School of Medicine, Galveston, TX, United States

Background: Workflow efficiency plays a critical role in ensuring safe, effective patient care and in supporting residents' well-being. Redundancies and inefficiency in daily tasks can cause resident frustration, which can ultimately lead to communication errors during handoffs. In our newborn nursery, we have been using a shared Excel sheet outside the electronic medical record (EMR) to keep track of our patients.

Objective: To decrease the documentation time in the newborn nursery handoff process by 20% by implementing EMR optimization to improve resident satisfaction over six months.

Design/Methods: This quality improvement project took place in a robust newborn nursery in a large academic center. Using the Plan-Do-Study-Act (PDSA) model, we developed and implemented a standardized EPIC-based handoff tool to replace a shared Excel spreadsheet. A key driver diagram guided the intervention, with baseline data collected. The PDSA cycles included: 1) information gathering on current workflow and handoff utilization, 2) launching a pre-intervention survey to assess resident satisfaction and perceived workflow challenges, 3) designing and refining the standardized EPIC-based handoff tool with input from residents, 4) education tools to prepare for intervention, 5) implementation and 6) post-intervention survey to evaluate changes in satisfaction and perceived workflow efficiency compared to baseline.

Results: Comparisons of our preintervention and postintervention surveys reveal significant improvements across nearly every metric following the implementation of the EMR-based handoff tool. In particular, communication clarity rose from 10% to 67%, and accuracy from 0% to 78% respectively. Ease of use improved from 7% to 81%, along with workflow and time efficiency from 10% to 74%. Importantly, negative perceptions of wellbeing and feelings of being overwhelmed both decreased from 65% to 30%. Time to complete written handoff decreased significantly from 87 seconds ± 23.2 to 9.1 seconds ± 9.2 (p < 0.001). Overall, these findings show that transitioning to an EMR-integrated handoff tool significantly enhanced clarity, accuracy, usability, and satisfaction while reducing workload burden and inefficiency.

Conclusion(s): Transitioning to a structured EMR-based handoff tool has the potential to improve communication, efficiency, and resident experience in the newborn nursery. Over a series of 6 PDSA cycles, significant improvement was noted. Future efforts will focus on long-term sustainability and potential adaptation across other pediatric units.

Driver Diagram


Pre- and Post-Intervention Survey Results


Comparison of Resident Satisfaction Before and After EMR Handoff Tool Implementation Using Wilcoxon Rank-Sum Test