Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Susan Penque, PhD, APRN, ANP-BC, NE-BC, NC-C
Practice Mentor
Phyllis Yezzo, DNP, RN, CPHQ, NEA-BC
Abstract
The DNP practice site, a high-acuity Level I trauma center and regional referral hub, experiences persistent emergency department (ED) crowding and prolonged admission throughput times. Regional data show average ED wait-times near 252 minutes, underscoring the urgency of reducing delays between bed assignment and bed occupancy (assigned-to-occupied time). Inefficient or varied written handoffs contribute to calls for clarification, omissions, and transition delays, where structured, electronic SBAR tools are associated with improved completeness, standardization, and workflow efficiency. At the systems level, prolonged ED boarding is linked to higher daily hospital costs and safety risks, making communication optimization an operational and patient-safety priority for WMC.
Project Goals
- Reduce assigned-to-occupied bed-times for admitted ED patients by implementing an electronic SBAR within the EHR.
- Increase handoff quality and consistency, measured by completeness and compliance with SBAR elements.
- Improve nurse satisfaction with the handoff process.
- Support sustainable adoption through policy integration, targeted education, and ongoing performance feedback aligned to the Johns Hopkins EBP “Translation” phase.
Methods
This quality improvement project, guided by the Johns Hopkins Evidence-Based Practice (JH-EBP) Model, was conducted in the Emergency Department of the DNP practice site. The Practice Question phase identified delays in assigned-to-occupied bed-times potentially associated with inconsistent written SBAR handoff communication. During the Evidence phase, internal throughput data and external literature on structured electronic handoff tools were appraised to inform the intervention.
In the Translation phase, an electronic SBAR template was developed and embedded in the electronic health record to standardize and streamline ED-to-inpatient nurse handoffs. Staff and ED providers (MD, NP) were introduced to the updated process through unit-based microlearning sessions and point-of-care tip sheets.
Primary outcome data included assigned-to-occupied bed-times extracted from EHR timestamps before and after implementation. Process measures included SBAR completion and compliance audits. Analysis consisted of descriptive statistics and comparison of time-interval means to determine whether the electronic SBAR improved the efficiency of ED patient transitions relative to written SBAR use.
Results
Project findings demonstrated that implementing the electronic SBAR handoff in the ED was associated with a meaningful reduction of 28 minutes in assigned-to-occupied bed-times for admitted Med-Surg patients. Improvements were observed consistently, with throughput data showing a downward trend in the time required for patients to transition from bed assignment to bed occupancy. Process indicators also showed positive gains, including increased SBAR completion and improved handoff completeness, particularly for safety-critical fields such as code status, isolation precautions, and active drips. No unintended increases in documentation burden or workflow disruption were identified, and staff required minimal acclimation to achieve consistent use. These results support the feasibility and effectiveness of the electronic SBAR as a strategy to enhance communication efficiency and patient flow.
Conclusion
The improvements observed following the implementation of the electronic SBAR indicate that standardized, electronic handoff tools can strengthen transition of care processes and reduce admission delays in high-acuity environments. By enhancing communication clarity and reducing variability in handoff quality, the intervention supports safer, more efficient patient movement from the ED to inpatient units. These promising results underscore the value of integrating evidence-based communication tools within the EHR and highlight the importance of supporting such initiatives with structured education, informatics collaboration, and workflow alignment. The electronic SBAR demonstrates strong potential for long-term organizational impact and may serve as a scalable model for other departments seeking to improve throughput and care coordination.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Candito. S. (2026). Leveraging technology to improve throughput: A QI project utilizing electronic SBAR [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.