HYBRID EVENT: You can participate in person at Baltimore, Maryland, USA or Virtually from your home or work.

8th Edition of Nursing World Conference

October 17-19, 2024 | Baltimore, USA

October 17 -19, 2024 | Baltimore, USA
NWC 2023

Kristyn Melsenti

Speaker at  Nursing World Conference 2023 - Kristyn Melsenti
Yale New Haven Hospital, United States
Title : EMR handoff and PACU pause increases perioperative patient safety


Brief Description:

We explored concepts of high reliability between perioperative disciplines by incorporating a surgical patient handoff tool that builds in "real time." The tool starts building in the pre-operative phase of care, into the operating room and eventually into the post-anesthesia care unit or intensive care unit, ultimately delivering care continuity.


Handoff communication is a Joint Commission National Patient Safety Goal. Ineffective communication between healthcare providers can lead to sentinel events and may be the reason for errors in healthcare. Using an embedded EMR report may lead to improved communication

Relevance/Significance (why):

OR handoff is pressed to achieve stringent turnover times resulting in dissatisfied receiving RNs and unsafe patient care outcomes. Poor handoffs have led to strain in OR and PACU relationships. Verbal bedside report isn't sufficient enough for a safe handoff. Rushing to write down report leads to miscommunications and hesitancy to ask questions. Implementation of efficiently built EMR based tool in conjunction with PACU pause will increase nurse concentration and improve patient safety.

Strategy/Implementation/Methods (How):

Implementation of efficiently built EMR based handoff that can pull in information from the chart will save time and relieve pressure of rushed handoff at bedside. This quality improvement initiative will have a focus on safety before efficiency. Anesthesia providers can have more efficient continuity of care for provider turnover and break coverage within a single case. A pilot was conducted in North PACU, which has a mix of ambulatory and in-patient cases. The tool was utilized by staff and a survey was collected for feedback.

Evaluation/Outcomes/Results (So what):

The tool was optimized to follow handoff workflow, the tool bridges gaps in communication from the pre-operative phase of care through perioperative disposition. We have seen an improvement in the relationships between Anesthesia and PACU staff, anesthesiologists have been able to provide more efficient continuity of care during case coverage and handoff. We have seen a reduction in our "transitions of care" risk level matrix, and overall, an increase in the management of the PACU patient.

Conclusions/Implications (And now):

YNHHS staff survey revealed gaps in communication between disciplines and phases of care. Incorporating an electronic handoff tool has bridged gaps in communication for perioperative patients; leading to positive patient outcomes, safer handoffs and strengthened interdisciplinary relationships.


Kristyn Melsenti is the Nursing Professional Development Specialist for Yale New Haven Hospital Pre-Op and Post-Anesthesia Care unit. She is an active member of ASPAN and local CSPAN organizations. Serves as evidence-based practice mentor for Perioperative Nursing Professional Governance and hold professional Stroke certification. Kristyn is co-founder of PACU documentation charter and Perioperative leaders across Yale Health System. She collaborates across multiple disciplines to improve quality and safety of patient care for surgical patients. She has been published for her work on fall reduction within inner-city community hospital settings.
Kristyn is a graduate of Seton Hall University with her Masters of Science in Nursing (MSN, 2012), (RN, 2011) co-founder of “Leaders in Healthcare” which is still currently practicing in community outreach at Seton Hall University in New Jersey.