Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Sandra Spoelstra, PhD, RN, FGSA, FAAN

Second Advisor

Marie VanderKooi, DNP, MSN RN-BC

Third Advisor

Caryn Steenland, MSN, RN


Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place in a free-standing children’s hospital, and involved registered nurses (N=168) and patients. The Plan, Do, Study, Act model was utilized to direct change. Outcomes were evaluated using pre- and post-data collected from surveys, report reviews, and organizational reports. Implementation of a standardized process with a cognitive aid had a statistically significant impact on use of the standardized handover process and registered nurse satisfaction without increasing transition time. Sustained increase in compliance with the process was achieved with use of the cognitive aid. Improvement was attributed to multiple, evidence-based, and tailored implementation strategies. Implementation of a cognitive aid within an established workflow and compliance tracking is likely to increase and sustain use of the standardized transition process during patient handover and improve registered nurse satisfaction.