Improving handoffs in the emergency department.

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area.

[1]  William B Lober,et al.  A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. , 2005, Journal of the American College of Surgeons.

[2]  Carolyn M Clancy,et al.  Care Transitions: A Threat and an Opportunity for Patient Safety , 2006, American journal of medical quality : the official journal of the American College of Medical Quality.

[3]  MHS Leora I. Horwitz MD,et al.  Development and Implementation of an Oral Sign-out Skills Curriculum , 2007, Journal of General Internal Medicine.

[4]  M. Kerr.  A qualitative study of shift handover practice and function from a socio-technical perspective. , 2002, Journal of advanced nursing.

[5]  P. Croskerry.  The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[6]  V. Arora,et al.  A model for building a standardized hand-off protocol. , 2006, Joint Commission journal on quality and patient safety.

[7]  Nancy Poole,et al.  Transfer of accountability: transforming shift handover to enhance patient safety. , 2006, Healthcare quarterly.

[8]  Ravi Behara,et al.  Transitions in Care: Signovers in the Emergency Department , 2004 .

[9]  W. Levinson.  Physician-patient communication. A key to malpractice prevention. , 1994, JAMA.

[10]  Brian McFetridge,et al.  An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit. , 2007, Nursing in critical care.

[11]  C. Scholle,et al.  Ticket to Ride: Reducing Handoff Risk During Hospital Patient Transport , 2009, Journal of nursing care quality.

[12]  T. Brennan,et al.  Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. , 1998, The Joint Commission journal on quality improvement.

[13]  A. Lyndon.  Communication and teamwork in patient care: how much can we learn from aviation? , 2006, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[14]  J. Cooper.  Do short breaks increase or decrease anesthetic risk? , 1989, Journal of clinical anesthesia.

[15]  Robert L. Wears,et al.  Shift Changes among Emergency Physicians: Best of Times, Worst of Times , 2003 .

[16]  Peter J Pronovost,et al.  A practical tool to learn from defects in patient care. , 2006, Joint Commission journal on quality and patient safety.

[17]  Emily S. Patterson,et al.  Shift Changes, Updates, and the On-Call Architecture in Space Shuttle Mission Control , 2001, Computer Supported Cooperative Work (CSCW).

[18]  Robert L. Wears,et al.  Conceptual Framework for Studying Shift Changes and other Transitions in Care , 2004 .

[19]  P. Bierly.  Culture and High Reliability Organizations: The Case of the Nuclear Submarine: , 1995 .

[20]  Jeffrey B Cooper,et al.  Handoffs causing patient harm: a survey of medical and surgical house staff. , 2008, Joint Commission journal on quality and patient safety.

[21]  Robert L Wears,et al.  Beyond "communication failure". , 2009, Annals of emergency medicine.

[22]  C. Marano,et al.  To err is human. Building a safer health system , 2005 .

[23]  J. Singer,et al.  Emergency Physician Intershift Handovers: An Analysis of Our Transitional Care , 2006, Pediatric emergency care.

[24]  José Orlando Gomes,et al.  Handoff strategies in settings with high consequences for failure: lessons for health care operations. , 2004, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[25]  D. Meltzer,et al.  Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis , 2005, Quality and Safety in Health Care.

[26]  Kevin W. Smith,et al.  Financial Gains and Risks in Pay-for-Performance Bonus Algorithms , 2007, Health care financing review.

[27]  John Whittington,et al.  SBAR: a shared mental model for improving communication between clinicians. , 2006, Joint Commission journal on quality and patient safety.

[28]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[29]  K. McHardy,et al.  Passing the buck: clinical handovers at a tertiary hospital. , 2007, The New Zealand medical journal.

[30]  E. Cruz,et al.  Lost in the translation. , 1988, Chest.

[31]  Christopher Beach,et al.  Profiles in patient safety: emergency care transitions. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[32]  Rainer Dietrich,et al.  Group interaction in high risk environments , 2004 .

[33]  Robert L Wears,et al.  Communication in the emergency department: separating the signal from the noise , 2002, The Medical journal of Australia.

[34]  Barbara Stover Gingerich,et al.  Patient Safety Solutions , 2008 .

[35]  Francis T. Durso,et al.  Emergency Physician to Admitting Physician Handovers: An Exploratory Study , 2002 .

[36]  William B Lober,et al.  Organizing the transfer of patient care information: the development of a computerized resident sign-out system. , 2004, Surgery.

[37]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[38]  Thomas G. Dietterich,et al.  To transfer or not to transfer , 2005, NIPS 2005.

[39]  Douglas A Propp,et al.  Improving handoffs in the emergency department. , 2010, Annals of emergency medicine.

[40]  Lee Ann Riesenberg,et al.  Systematic Review of Handoff Mnemonics Literature , 2009, American journal of medical quality : the official journal of the American College of Medical Quality.

[41]  Simon Cooper,et al.  Patient handover: time for a change? , 2007, Accident and emergency nursing.

[42]  Tebogo Kgosietsile Letlape,et al.  Communication During Patient Hand-Overs: Patient Safety Solutions, Volume 1, Solution 3, May 2007 , 2007 .

[43]  Rollin J Fairbanks,et al.  Emergency department communication links and patterns. , 2007, Annals of emergency medicine.

[44]  S. Yentis,et al.  A national survey of obstetric anaesthetic handovers * , 2006, Anaesthesia.

[45]  A. O’Connor,et al.  Communication loads on clinical staff in the emergency department , 2002, The Medical journal of Australia.

[46]  Richard M Frankel,et al.  Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[47]  Emily S. Patterson,et al.  Shift Changes, Updates, and the On-Call Model in Space Shuttle Mission Control , 1997 .

[48]  Catherine Yoon,et al.  Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. , 2007, Annals of emergency medicine.