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Internal and Emergency Medicine

, Volume 13, Issue 3, pp 385–395 | Cite as

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

  • Kamna S. Balhara
  • Susan M. Peterson
  • Mohamed Moheb Elabd
  • Linda Regan
  • Xavier Anton
  • Basil Ali Al-Natour
  • Yu-Hsiang Hsieh
  • James Scheulen
  • Sarah A. Stewart de Ramirez
EM - ORIGINAL

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.

Keywords

Clinical handoff Emergency service, hospital Patient admission Inter-unit communication 

Notes

Compliance with ethical standards

Conflict of interest

The Authors declare that they have no conflict of interest.

Statement of human and animal rights

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.

Informed consent

Participants provided written consent.

References

  1. 1.
    Keyes C (2000) Coordination of care provision: the role of the ‘handoff’. Int J Qual Health Care 12:519CrossRefPubMedGoogle Scholar
  2. 2.
    Riesenberg LA, Leitzsch J, Massucci JL et al (2009) Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med 84:1775–1786CrossRefPubMedGoogle Scholar
  3. 3.
    Kitch BT, Cooper JB, Zapol WM et al (2008) Handoffs causing patient harm: a survey of medical and surgical housestaff. Jt Commun J Qual Patient Saf 34(10):563–570CrossRefGoogle Scholar
  4. 4.
    Horwitz LI, Meredith T, Schuur JD et al (2009) Dropping the baton: a qualitative analysis of failures during the transition from emergency department of inpatient care. Ann Emerg Med 53(6):701–710CrossRefPubMedGoogle Scholar
  5. 5.
    Solet DJ, Norvell JM, Rutan GH et al (2005) Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 80(12):1094–1099CrossRefPubMedGoogle Scholar
  6. 6.
    JCAHO (2005) JCAHO’s 2006 national patient safety goals: Handoffs are biggest challenge. Hosp Peer Rev 30(7):89–93Google Scholar
  7. 7.
    Joint Commission (2006) National Patient Safety Goals, 2006, Critical access hospital and hospital national patient safety goals. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/06_npsg_cah.htm. Accessed Dec 2015
  8. 8.
    Petersen LA, Orav EJ, Teich JM et al (1997) Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Commun J Qual Improv 24(2):77–87Google Scholar
  9. 9.
    Dubosh NM, Carney D, Fisher J et al (2014) Implementation of an emergency department sign-out checklist improves transfer of information at shift change. J Emerg Med 47(5):580–585CrossRefPubMedGoogle Scholar
  10. 10.
    Wayne JD, Tyagi R, Reinhardt G et al (2008) Simple standardized patient handoff system that increases accuracy and completeness. J Surg Educ 65(6):476–485CrossRefPubMedGoogle Scholar
  11. 11.
    Apker J, Mallak LA, Gibson SC (2007) Communicating in the “gray zone”: perceptions about emergency physician hospitalist handoffs and patient safety. Acad Emerg Med 14(10):884–894PubMedGoogle Scholar
  12. 12.
    Beach C, Cheung DS, Apker J et al (2012) Improving interunit transitions of care between emergency physicians and hospital medicine physicians: a conceptual approach. Acad Emerg Med 19(10):1188–1195CrossRefPubMedGoogle Scholar
  13. 13.
    Hilligoss B, Cohen MD (2013) The unappreciated challenges of between-unit handoffs: negotiating and coordinating across boundaries. Ann Emerg Med 61(2):155–160CrossRefPubMedGoogle Scholar
  14. 14.
    Kessler C, Scott NL, Siedsma M et al (2014) Interunit handoffs of patients and transfers of information: a survey of current practices. Ann Emerg Med 64(4):343–349CrossRefPubMedGoogle Scholar
  15. 15.
    Smith CJ, Britigan DH, Lyden E et al (2015) Interunit handoffs from emergency department to inpatient care: a cross-sectional survey of physicians at a university medical center. J Hosp Med. 10(11):711–717CrossRefPubMedGoogle Scholar
  16. 16.
    Fischer M, Hemphill RR, Rimler E et al (2012) Patient communication during handovers between emergency medicine and internal medicine residents. J Grad Med Ed 4(4):533–537CrossRefGoogle Scholar
  17. 17.
    Gurses AP, Kim G, Marsteller J et al (2012) Identifying and categorizing patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study. BMJ Qual Saf 21(10):810–818CrossRefPubMedGoogle Scholar
  18. 18.
    Gonzalo JD, Yang JJ, Stuckey HL et al (2014) Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. Int J Qual Health Care 26(4):337–347CrossRefPubMedGoogle Scholar
  19. 19.
    Joint Commission International Accreditation Standards for Hospitals (2013) 5th edition. http://www.jointcommissioninternational.org/assets/3/7/Hospital-5E-Standards-Only-Mar2014.pdf. Accessed January 2016
  20. 20.
    Joint Commission Center for Transforming Healthcare (2016) Facts about the Hand-off Communications Project. http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf. Accessed Mar 2016
  21. 21.
    Ogrinc G, Davies L, Goodman D et al (2015) SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual. doi: 10.1136/bmjqs-2015-004411 Google Scholar
  22. 22.
    Carayon P, Schoofs Hundt A, Karsh BT et al (2006) Review work system design for patient safety: the SEIPS model. Qual Saf Health Care 15:50–58CrossRefGoogle Scholar
  23. 23.
    Starmer AJ, O’Tooke JK, Rosenbluth G et al (2014) Development, implementation, and dissemination of the I-PASS handoff curriculum: a multisite educational intervention to improve patient handoffs. Acad Med 89(6):876–884CrossRefPubMedGoogle Scholar
  24. 24.
    Going Lean in Health Care (2005) IHI Innovation Series white paper. Institute for Healthcare Improvement, Cambridge. http://www.IHI.org. Accessed Dec 2015
  25. 25.
    Patterson ES (2008) Structuring flexibility: the potential good, bad and ugly in standardisation of handovers. Qual Saf Health Care 17:4e5CrossRefGoogle Scholar
  26. 26.
    Patterson ES, Woods DD (2001) Shift changes, updates, and the on-call architecture in space shuttle mission control. Comput Support Coop Work 10:317–346CrossRefPubMedGoogle Scholar
  27. 27.
    Arora V, Johnson J, Lovinger D et al (2005) Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care 14(6):401–407CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Sujan MA, Chessum P, Rudd M et al (2015) Emergency care handover (ECHO study) across care boundaries: the need for joint decision making and consideration of psychosocial history. Emerg Med J 32(2):112–118CrossRefPubMedGoogle Scholar
  29. 29.
    Joint Commission on Accreditation of Healthcare Organizations (2007) National Patient Safety Goals Hospital Version Manual Chapter. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_hap_cah_npsgs.thm. Accessed Dec 2015
  30. 30.
    McLeod JM, Chaffee SH (1973) Interpersonal approaches to communication research. Am Behav Sci 16:469–499CrossRefGoogle Scholar
  31. 31.
    Perry SJ, Wears RL, Patterson ES (2008) High-hanging fruit: improving transitions in health care. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches, vol 3: performance and tools. Agency for Healthcare Research and Quality (US), RockvilleGoogle Scholar
  32. 32.
    Patterson ES, Wears RL (2010) Patient handoffs: standardized and reliable measurement tools remains elusive. Jt Commun J Qual Patient Saf 36(2):52–61CrossRefGoogle Scholar
  33. 33.
    Kerr D, McKay K, Klim S et al (2015) Attitudes of emergency department patients about handover at the bedside. J Clin Nurs 23(11–12):1685–1693Google Scholar
  34. 34.
    Sheth S, McCarthy E, Kipps AK et al (2016) Changes in efficiency and safety culture after integration of an I-PASS-supported handoff process. Pediatrics 136(2):1–9Google Scholar
  35. 35.
    Federal Aviation Administration (2008) Section 12: Aircraft Checklists for 14 CFR Parts 121/135.https://www.faa.gov/regulations_policies/handbooks_manuals/aircraft/amt_handbook/media/FAA-8083-30_Ch12.pdf. Accessed Dec 2015
  36. 36.
    Thomassen O, Espeland A, Softeland E et al (2011) Implementation of checklists in health care; learning from high-reliability organizations. Scand J Trauma Resusc Emerg Med 19:53CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Pronovost P, Needham D, Berenholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732CrossRefPubMedGoogle Scholar
  38. 38.
    Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499CrossRefPubMedGoogle Scholar
  39. 39.
    Mullan PC, Macias CG, Hsu D et al (2015) A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification. Pediatr Emerg Care 31(4):231–238CrossRefPubMedGoogle Scholar
  40. 40.
    Hilligoss N (2014) Selling patients and other metaphors: a discourse analysis of the interpretive frames that shape emergency department handoffs. Soc Sci Med 102:119–128CrossRefPubMedGoogle Scholar

Copyright information

© SIMI 2017

Authors and Affiliations

  • Kamna S. Balhara
    • 1
  • Susan M. Peterson
    • 2
  • Mohamed Moheb Elabd
    • 3
  • Linda Regan
    • 2
  • Xavier Anton
    • 3
  • Basil Ali Al-Natour
    • 3
  • Yu-Hsiang Hsieh
    • 2
  • James Scheulen
    • 2
  • Sarah A. Stewart de Ramirez
    • 2
  1. 1.Department of Emergency MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  2. 2.Department of Emergency MedicineJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of Emergency MedicineAl Rahba HospitalAbu DhabiUnited Arab Emirates

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