{"id":{"repo_id":"msu","oai_identifier":"oai:d.lib.msu.edu:dnp_97"},"canonical_url":"https://search.dev.ndltd.org/etd/msu/oai:d.lib.msu.edu:dnp_97","repository":{"repo_id":"msu","name":"Michigan State University","base_url":"https://d.lib.msu.edu/oai"},"display":{"title":"Improving care coordination through virtual warm handoffs in telepsychiartry","abstract":"Problem: Community telehealth psychiatry often experiences inconsistent handoffs between providers and nurses. This can result in missed nursing assessments, delays in lab work or vital-sign checks, and fragmented follow-up care, especially for patients on medications like lithium, valproate, or clozapine that require specific monitoring as per guidelines. Purpose: This QI/EBP DNP project assessed whether implementing a structured provider-to-nurse SBAR handoff would enhance the completion of nursing assessments in a community outpatient behavioral health clinic. Methods: This intervention was implemented at a single CNS Healthcare clinic through three sequential Plan-Do-Study-Act cycles over 12 weeks, starting with small-scale testing and expanding to four nurse-provider pairs. The workflow used Doxy.me call transfer to move patients from provider visits to nursing follow-up, supplemented by standardized SBAR communication. If a live handoff was not possible, SBAR messages were sent via Microsoft Teams. Nursing follow-up was tracked using telehealth T1002 billing codes, comparing a 53-business-day baseline to post-implementation performance. Results: Baseline follow-up was 20.9% (362/1,731 provider encounters). After implementation, the combined follow-up rate across PDSA cycles increased to 73.5% (642/873), a 52.6 percentage-point improvement (p < .001). Performance improved across all cycles, though variation persisted between nurse-provider pairs. Conclusions: Implementing a structured telehealth handoff with call transfer and SBAR communication significantly improved the reliability of nursing follow-up in community psychiatry. Standardizing this workflow may enhance team-based care, decrease care fragmentation, and strengthen care continuity in telehealth settings.","abstract_html":"Problem: Community telehealth psychiatry often experiences inconsistent handoffs between providers and nurses. This can result in missed nursing assessments, delays in lab work or vital-sign checks, and fragmented follow-up care, especially for patients on medications like lithium, valproate, or clozapine that require specific monitoring as per guidelines. Purpose: This QI/EBP DNP project assessed whether implementing a structured provider-to-nurse SBAR handoff would enhance the completion of nursing assessments in a community outpatient behavioral health clinic. Methods: This intervention was implemented at a single CNS Healthcare clinic through three sequential Plan-Do-Study-Act cycles over 12 weeks, starting with small-scale testing and expanding to four nurse-provider pairs. The workflow used Doxy.me call transfer to move patients from provider visits to nursing follow-up, supplemented by standardized SBAR communication. If a live handoff was not possible, SBAR messages were sent via Microsoft Teams. Nursing follow-up was tracked using telehealth T1002 billing codes, comparing a 53-business-day baseline to post-implementation performance. Results: Baseline follow-up was 20.9% (362/1,731 provider encounters). After implementation, the combined follow-up rate across PDSA cycles increased to 73.5% (642/873), a 52.6 percentage-point improvement (p &lt; .001). Performance improved across all cycles, though variation persisted between nurse-provider pairs. Conclusions: Implementing a structured telehealth handoff with call transfer and SBAR communication significantly improved the reliability of nursing follow-up in community psychiatry. Standardizing this workflow may enhance team-based care, decrease care fragmentation, and strengthen care continuity in telehealth settings.","abstract_has_math":false,"creators":["Gines, Spencer"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Jones-Brown, Natalie"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026","date_published":"2026","updated_at":"2026-07-24T03:16:39Z","subjects":["Community mental health services","Medical telematics","Nursing assessment"],"languages":["English"],"rights":["In Copyright"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["dnp:97","oclc:1601633871","local:R_5oQIwzlLcFmqTuQ"],"render_values":[{"text":"dnp:97","href":null,"code":true},{"text":"oclc:1601633871","href":null,"code":true},{"text":"local:R_5oQIwzlLcFmqTuQ","href":null,"code":true}]}]},"links":{"outbound_url":"https://doi.org/doi:10.25335/9jgn-kz29","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Jones-Brown, Natalie"]},{"key":"dc:creator","label":"Author","values":["Gines, Spencer"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026"]},{"key":"dc:relation","label":"Dc Relation","values":["Doctor of Nursing Practice Projects"]},{"key":"dc:type","label":"Dc Type","values":["Text","Theses"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Community mental health services","Medical telematics","Nursing assessment"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["English"]},{"key":"dc:rights","label":"Dc Rights","values":["In Copyright"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["dnp:97","oclc:1601633871","local:R_5oQIwzlLcFmqTuQ","https://doi.org/doi:10.25335/9jgn-kz29"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Problem: Community telehealth psychiatry often experiences inconsistent handoffs between providers and nurses. This can result in missed nursing assessments, delays in lab work or vital-sign checks, and fragmented follow-up care, especially for patients on medications like lithium, valproate, or clozapine that require specific monitoring as per guidelines. Purpose: This QI/EBP DNP project assessed whether implementing a structured provider-to-nurse SBAR handoff would enhance the completion of nursing assessments in a community outpatient behavioral health clinic. Methods: This intervention was implemented at a single CNS Healthcare clinic through three sequential Plan-Do-Study-Act cycles over 12 weeks, starting with small-scale testing and expanding to four nurse-provider pairs. The workflow used Doxy.me call transfer to move patients from provider visits to nursing follow-up, supplemented by standardized SBAR communication. If a live handoff was not possible, SBAR messages were sent via Microsoft Teams. Nursing follow-up was tracked using telehealth T1002 billing codes, comparing a 53-business-day baseline to post-implementation performance. Results: Baseline follow-up was 20.9% (362/1,731 provider encounters). After implementation, the combined follow-up rate across PDSA cycles increased to 73.5% (642/873), a 52.6 percentage-point improvement (p < .001). Performance improved across all cycles, though variation persisted between nurse-provider pairs. Conclusions: Implementing a structured telehealth handoff with call transfer and SBAR communication significantly improved the reliability of nursing follow-up in community psychiatry. Standardizing this workflow may enhance team-based care, decrease care fragmentation, and strengthen care continuity in telehealth settings.","Thesis (D.N.P.)--Michigan State University. Psychiatric mental health practitioner, 2026","Includes bibliographical references (pages 47-51)"]},{"key":"dc:format","label":"Dc Format","values":["60 pages"]},{"key":"dc:title","label":"Title","values":["Improving care coordination through virtual warm handoffs in telepsychiartry"]}]}],"canonical_facts":{"dc:contributor":["Jones-Brown, Natalie"],"dc:creator":["Gines, Spencer"],"dc:date":["2026"],"dc:description":["Problem: Community telehealth psychiatry often experiences inconsistent handoffs between providers and nurses. This can result in missed nursing assessments, delays in lab work or vital-sign checks, and fragmented follow-up care, especially for patients on medications like lithium, valproate, or clozapine that require specific monitoring as per guidelines. Purpose: This QI/EBP DNP project assessed whether implementing a structured provider-to-nurse SBAR handoff would enhance the completion of nursing assessments in a community outpatient behavioral health clinic. Methods: This intervention was implemented at a single CNS Healthcare clinic through three sequential Plan-Do-Study-Act cycles over 12 weeks, starting with small-scale testing and expanding to four nurse-provider pairs. The workflow used Doxy.me call transfer to move patients from provider visits to nursing follow-up, supplemented by standardized SBAR communication. If a live handoff was not possible, SBAR messages were sent via Microsoft Teams. Nursing follow-up was tracked using telehealth T1002 billing codes, comparing a 53-business-day baseline to post-implementation performance. Results: Baseline follow-up was 20.9% (362/1,731 provider encounters). After implementation, the combined follow-up rate across PDSA cycles increased to 73.5% (642/873), a 52.6 percentage-point improvement (p < .001). Performance improved across all cycles, though variation persisted between nurse-provider pairs. Conclusions: Implementing a structured telehealth handoff with call transfer and SBAR communication significantly improved the reliability of nursing follow-up in community psychiatry. Standardizing this workflow may enhance team-based care, decrease care fragmentation, and strengthen care continuity in telehealth settings.","Thesis (D.N.P.)--Michigan State University. Psychiatric mental health practitioner, 2026","Includes bibliographical references (pages 47-51)"],"dc:format":["60 pages"],"dc:identifier":["dnp:97","oclc:1601633871","local:R_5oQIwzlLcFmqTuQ","https://doi.org/doi:10.25335/9jgn-kz29"],"dc:language":["English"],"dc:relation":["Doctor of Nursing Practice Projects"],"dc:rights":["In Copyright"],"dc:subject":["Community mental health services","Medical telematics","Nursing assessment"],"dc:title":["Improving care coordination through virtual warm handoffs in telepsychiartry"],"dc:type":["Text","Theses"]},"updated_at":"2026-07-24T03:16:39Z"}