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Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine

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Abstract

Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9–13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, MC 7736, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Kamna S. Balhara

  2. Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA

    Susan M. Peterson, Linda Regan, Yu-Hsiang Hsieh, James Scheulen & Sarah A. Stewart de Ramirez

  3. Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates

    Mohamed Moheb Elabd, Xavier Anton & Basil Ali Al-Natour

Authors
  1. Kamna S. Balhara
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  2. Susan M. Peterson
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  3. Mohamed Moheb Elabd
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  4. Linda Regan
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  5. Xavier Anton
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  6. Basil Ali Al-Natour
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  7. Yu-Hsiang Hsieh
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  8. James Scheulen
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  9. Sarah A. Stewart de Ramirez
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Correspondence to Kamna S. Balhara.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Appendix

Observation checklist.

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Balhara, K.S., Peterson, S.M., Elabd, M.M. et al. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine. Intern Emerg Med 13, 385–395 (2018). https://doi.org/10.1007/s11739-017-1615-y

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