Abstract Miscommunication or omission of critical patient information contributes to preventable medical errors that result in 98,000 patient deaths each year. The hand-off communication process creates a critical time for the patient as necessary information for the continuity of care must be communicated. The purpose of this practice project was to evaluate the nurses' perception of the current hand-off communication process before and after an educational intervention and implementation of the I-5 Verification of Information Tool. Registered nurses were asked to complete a pre survey of their perception of the current hand-off communication process, followed by an educational power point describing the I-5 Verification of Information Tool. Participants utilized the I-5 Verification of Information Tool during hand-off over a 3-week period, and then were asked to complete a post survey to evaluate the nurses' perception of the hand-off process including of the I-5 Verification of Information Tool. A paired t test was used to determine if there was a difference in the nurses' perception of the current hand-off communication process before and after an educational intervention and implementation of the I-5 Verification of Information Tool. Although there was no statistically significant difference in the pre- and post-survey scores, post survey results demonstrated clinical significance. This project has implications for positive social change by addressing nurse communication as a method to improve the quality of hand-off reports, which has the potential to reduce medical errors and improve patient outcomes.

A hand-off represents the transfer of patient information and care responsibility between a sending and receiving provider. Hand-offs occur in single locations such as inpatient wards and across care settings like from primary care offices to emergency departments. This care transition quality improvement (QI) project was created to improve patient hand-off communication from a primary care office to a hospital based emergency department within the greater Phoenix, AZ metropolitan area. No uniform hand-off process existed before the QI project. The purpose of the QI project was to demonstrate process necessary to achieve desired outcomes, in this case, a superior patient hand-off. The QI project goal was to develop a standardized hand-off protocol and tool. The aim of this QI project was to replace existing hand-off methods with a formalized new hand-off process and tool used during care transition from a primary care office to an emergency department. QI project methods followed two (2) plan-do-study-act (PDSA) cycles involving QI team meetings and end-user feedback that iteratively led to the adoption of a standardized hand-off process and tool. PDSA cycle one identified the best handoff tool. PDSA cycle two established an efficient process for conducting hand-offs. The new hand-off tool consistently demonstrated superior information transfer. Program participant satisfaction increased and was reflected by positive feedback as most nurses and doctors embraced the new process.

The Joint Commission reported that communication failures in United States hospitals contribute to 30% of all malpractice claims, and in 2008, The Joint Commission listed the improvement of effective communication among healthcare providers as a National Patient Safety Goal. The purpose of this practice-focused project was to develop a scenario-based communication simulation for implementation approval by a panel of experts. The approved curriculum was designed to integrate a communication-based simulation scenario into the nurse residency program of a large, urban medical center to improve new graduate nurse communication skills, increase nurse communication competency and self-efficacy, and decrease communication errors. Kolb's experiential learning theory guided the simulation-based educational project. The Delphi technique was used to achieve consensus, which was achieved with 1 Delphi round. The education curriculum was presented to a 5-member expert panel that included chief nursing officers and the staff development directors. The curriculum received panel feedback and approval for implementation in the 2019 nurse residency program. Key comments from the expert panel indicated that the curriculum was approved without major changes. A simulation communication curriculum integrated into the nurse residency program may effect positive social change by decreasing errors and improving patient outcomes.

Hand-off communication from the emergency department (ED) to inpatient nurses is an important process for transfer of safe and quality patient care from one department to another. Annually, there are130.4 million ED visits with 12.2 million of those visits resulting in hospital admission, providing ample opportunities for poor communication (Rui, Kang, & Albert, 2013). Miscommunications during patient hand-off are estimated to contribute to 80% of adverse events (The Joint Commission, 2012). This theory-driven, quality improvement project sought to evaluate the hand-off communication process between nurses from the ED and nurses in the inpatient Medical/Surgical units using human factors System Engineering Initiative for Patient Safety (SEIPS) approach, originally created by Pasqual Carayon in 2006. An online survey was created using an adapted SEIPS Model evaluating the interactive concepts of person, tools and technologies, tasks, organization, and environment and their impact on staff and patient outcomes. The survey was distributed to both the ED and Medical/Surgical nurses to gain their perspective on the interdepartmental hand-off communication process and how it impacts the staff and patient outcomes. There as an included option for the bedside nurses to provide recommendations on how to improve the hand-off communication process. Data was collected, anonymously, through an online database and descriptive statistics were used to analyze the results. The quality improvement project found that majority of nurses prefer verbal hand-off communication with a structured standard format of delivery in conjunction with the electronic health record. The project found that nurses perceive that the nurse-to-patient ratio and surrounding tasks impact the effectiveness and quality of hand-off communication. The most common suggested hand-off communication improvements were to not allow hand-off communication or transfer of the patient from the ED to the Medical/Surgical unit during peak times, such as shift change, and to follow up on tools and technology compliance. Overall, the person, the tools and technologies, the tasks, and the environment are contributing to ineffective hand-off, while the organization has adequately provided the resources the staff needs to perform an effective hand-off communication. All of which were concluded to have an impact on the staff and patient outcomes.

There is a growing range of IP-based data and voice applications using mobile devices (e.g. 3rd , 4th generation mobile phones and PDAs) and new access technologies (e.g. Bluetooth, 802.11, GPRS, ADSL). This growth is driving a desire to support mobility at the IP level � in other words, allowing an IP host to keep on communicating with other hosts while roaming between different IP subnetworks. Mobile IPv6 allows hosts to move their physical and topological attachment points around an IPv6 network while retaining connectivity through a single, well-known Home Address. Although Mobile IPv6 has been the subject of simulation studies, the real-world dynamic behavior of Mobile IPv6 is only gradually being experimentally characterised and analysed. This thesis reviews the use of Mobile IPv6 to support mobility between independent 802.11b-attached IPv6 subnets, and experimentally measures and critically evaluates how long an end to end IP path is disrupted when a Mobile IPv6 node shifts from one subnetwork to another (handoff time). The thesis describes the development of an experimental testbed suitable for gathering real-world Mobile IPv6 handoff data using publicly available, standards compliant implementations of Mobile IPv6. (An open-source Mobile IPv6 stack (the KAME release under FreeBSD) was deployed). The component of handoff time due to 802.11b link layer handoff is measured separately to assess its impact on the overall Mobile IPv6 handoff time. Using Mobile IPv6 handoff results, the likely performance impact of Mobile IPv6 handoff on a common webcam application and a bulk TCP data transfer is also evaluated. The impact of handoff on these applications clearly shows that a default Mobile IPv6 environment would be highly disruptive to real-time and interactive applications during handoff events, even if the underlying link-layer handoff was instantaneous.

Location Management is defined as the process of tracking the position of a mobile terminal when it moves to its associated area within the network. This allows the network to detect the mobile user’s path for the purpose of call delivery. The location management schema in a public-LAN mobile network (IS-41 and GSM) is based on centralized two-tier database architecture. The root level is called the Home Location Register (HLR) and the second level is called the Visitor Location Register (VLR). The HLR permanently stores all the mobile users’ location information and the types of services subscribed in the user’s profile database. The VLR stores the location information whenever a user registered in the HLR moves to its related location area within the network. By contacting the HLR, the VLR authenticates and updates the mobile user’s current position when a mobile terminal moves from one location area to another. The HLR then updates the mobile terminal’s new location information and removes the mobile terminal from its previous VLR. There can be multiple VLR’s under each HLR in a network. In the current location management schema, all the information requests, queries, acknowledgements have to go through the HLR. This results in excessive overload at the HLR. This overload becomes high when the number of mobile terminals increases within the network. The heavy traffic at the root (HLR) may cause congestion, degradation of the bandwidth at the root and hence becomes a major bottleneck for the entire network. To solve this congestion/bottleneck problem, a modified iterative protocol with VLR cache was introduced, where the VLRs in the network handle all de-registration, registration and acknowledgement of messages. The HLR only handles updating the location information of the mobile terminal in its database. This reduced the excess load/traffic experienced at the HLR thus improving the network’s performance. The modified protocol was tested with different cache replacement policies such as First-In First-Out (FIFO), Random and Least Frequently Visited (LFV) with uniform traffic with random mobile terminal movement. In this thesis report, we extend the previous work in the modified iterative protocol by 1) increasing the topography of the network, to analyze the impact of network’s size on performance and 2) changing the mobile terminal traffic pattern from uniform traffic with random mobile terminal movement to non-uniform traffic with unbalanced probability movement. With these changes, we analyzed the modified protocol’s performance with different cache replacement policies (FIFO, LFV and Random) under uniform traffic with random movement and non-uniform traffic with unbalanced probability movement.

An ever-growing body of evidence supports the efficacy of integrated care as a treatment approach; however, less is known about what specific components of integrated care are most effective. This is especially true of warm handoffs, which are an often discussed but understudied process in integrated care. A total of 246 patient charts were reviewed to determine if type of referral (warm handoff or traditional) increased the likelihood of follow-up with behavioral health services as well as factors that might impact this relationship. There were no significant differences between type of referral and likelihood of follow-up with behavioral health services. Only previous number of visits with referring provider significantly increased the likelihood of patients attending a subsequent behavioral health appointment. More research is needed to better understand the efficacy, if any, of the warm handoff as a component of integrated care.

Background: Within health care communication is an essential prerequisite for a working system. When communication between different parties works well it results in good care. Communication failure has been proven to be the main reason for adverse events in health care. Another important aspect in the provision of good health care is to have good hand-offs between different health care providers and units. Previous research demonstrates that hand-offs between units are strongly linked to jeopardizing patient safety.   Aim: The aim with this literature review was to identify factors that affect hand-offs between different units Method: A literature review with a thematic analysis of ten qualitative articles  Result: Two themes and four subthemes were identified. “Circumstances during hand-off” with subthemes time available for the hand-off and organizational factors. The other theme was “Communication during hand-off” with subthemes interaction between nurses and what is said. Conclusion: Even though hand-off between units is an indigenous part of health care it is still being affected by factors that could be changed through extracting and implementing evidence-based methods. / Bakgrund: Inom hälso-och sjukvården utgör kommunikation en viktig förutsättning för ett fungerande system. När kommunikationen mellan olika parter inom vården fungerar bra resulterar detta även i god vård. Brister i kommunikation har visat sig vara en av de största orsakerna till vårdskador. Utöver en god kommunikation är bra överrapporteringar viktiga för att patienter ska få god vård mellan olika vårdpersonal och vårdenheter. Tidigare forskning visar att överrapporteringar mellan olika vårdenheter är starkt förknippat med risker i patientsäkerheten. Syfte: Syftet med denna litteraturöversikt var att identifiera faktorer som påverkar överrapporteringar mellan olika vårdenheter. Metod: En litteraturöversikt med en tematisk analys av tio kvalitativa artiklar.  Resultat: Två teman och fyra subteman identifierades. ”Omständigheter under överrapporteringen” med subteman disponibel tid för överrapporteringen och organisatoriska faktorer. Det andra temat var ”kommunikation under överrapporteringen” med subteman interaktion mellan vårdpersonal och vad som sägs. Slutsats: Trots att överrapporteringar mellan olika avdelningar är en naturlig del av vården påverkas de av faktorer som skulle kunna förändras genom framställandet och implementeringen av evidensbaserade metoder.

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Robustness of a system has been defined in various ways and a lot of work has been done to model the robustness of a system, but quantifying or measuring robustness has always been very difficult. In this research, we develop a framework for robust system architecture. We consider a system of a linear estimator (multiple tap filter) and then attempt to model the system performance and robustness in a graphical manner, which admits an analysis using the differential geometric concepts. We compare two different perturbation models, namely the gradient with biased perturbations (sub-optimal model) of a surface and the gradient with unbiased perturbations (optimal model), and observe the values to see which of them can alternately be used in the process of understanding or measuring robustness. In this process we have worked on different examples and conducted many simulations to find if there is any consistency in the two models. We propose the study of robustness measures for estimation/prediction in stationary and non-stationary environment using differential geometric tools in conjunction with probability density analysis. Our approach shows that the gradient can be viewed as a random variable and therefore used to generate probability densities, allowing one to draw conclusions regarding the robust- ness. As an example, one can apply the geometric methodology to the prediction of time varying deterministic data in imperfectly known non-stationary distribution. We also compare stationary to non-stationary distribution and prove that robustness is reduced by admitting residual non-stationarity. We then research and develop a robust iterative handoff algorithm, relating generally to methods, devices and systems for reselecting and then handing over a mobile communications device from a first cell to a second cell in a cellular wireless communications system (GPRS, W-CDMA or OFDMA). This algorithm results in significant decrease in amount of power and/or result is a decrease of break in communications during an established voice call or other connection, in the field, thereby outperforming prior art.