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Improving transitions of care: Post-Mohs communication
Dissertation

Improving transitions of care: Post-Mohs communication

Michaela Carle
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: When transitions of care lack effective communication, hospital readmissions, medication errors, and increased costs due to avoidable complications occur. At the project site, communication gaps between facilities after Mohs surgery led to a reported increase in phone calls, delays in wound care and poor patient outcomes. The literature suggested that standardized handoffs improve communication, warm handoffs increase reliability of information transferred, written communication, such as discharge summaries, reduces errors, and the I-PASS tool improves handoff quality and reduces adverse events. Purpose: The purpose of this project was to use evidence-based postoperative handoffs to improve the communication of wound care and follow-up instructions for older adult patients undergoing Mohs procedures between the dermatology outpatient surgery clinic and the receiving post-acute facilities. Methods: Using The Iowa Model Revised framework, a standardized workflow incorporating a warm handoff based on the I-PASS tool, faxing written instructions, and standardized documentation was implemented in a dermatology clinic at a large academic medical center in the Midwest. Data were collected via electronic health record audits at three and six months post-implementation. Descriptive statistics were used to analyze completion rates of outcome measures. Findings: Of 601 Mohs surgical encounters reviewed, four patients met the inclusion criteria. Completion rates for warm handoffs, faxed wound care instructions, and standardized documentation were 50% (2/4) each. The project objectives of a 70% goal for completion rates were not met. Discussion: Findings suggest that a standardized handoff process can be integrated into outpatient surgical settings. Limitations included low patient volume meeting criteria and reliance on staff memory to complete the new process. Future studies could include electronic health record workflow integration, evaluation of patient outcomes, and a larger number of participants.
 transitions of care handoff postoperative communication Mohs surgery I- PASS evidence-based practice

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