A Survey of Handoff Practices in Emergency Medicine

Kessler, Chad; Shakeel, Faizan; Hern, H. Gene; Jones, Jonathan Spencer; Comes, Jim; Kulstad, Christine; Gallahue, Fiona E.; Burns, B.; Knapp, Barry; Gang, Maureen; Davenport, Moira; Osborne, Ben; Velez, Larissa I.

doi:10.1177/1062860613503364

Cited by 10 publications

(9 citation statements)

References 22 publications

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“…This is consistent with the existing literature, which showed that less than half of EM programs had a standardized handoff practice in 2013 12. A standardized handoff practice has been introduced to several inter-unit handoff processes, namely using mnemonics and checklists 14,31.…”

Section: Discussionsupporting

confidence: 90%

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Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm

Lee¹,

Jordan²,

Hern³

et al. 2017

WestJEM

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IntroductionWe aimed to assess the current scope of handoff education and practice among resident physicians in academic centers and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED) to an inpatient setting.MethodsThis was a cross-sectional survey targeted at the program directors, associate or assistant program directors, and faculty members of emergency medicine (EM) residency programs in the United States (U.S.). The web-based survey was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff.Results121 of 172 programs responded to the survey for an overall response rate of 70.3%. Our survey showed that most EM programs in the U.S. have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system, over 70% of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess the handoff proficiency of trainees. Handoffs most commonly take place over the phone, though respondents disagree about the ideal place for a handoff to occur, with nearly equivalent responses between programs favoring the bedside over the phone or face-to-face on a computer. Approximately two-thirds of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and on the review of the literature, we developed a five-step algorithm for the transition of care from the ED to the inpatient setting.ConclusionOur results identified the current trends of education and practice in transitions of care, from the ED to the inpatient setting in U.S. academic medical centers. An algorithm, which guides this process, is proposed to address the current gap in the standardized approach to ED to inpatient handoffs that were identified in the survey’s assessment of needs.

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Section: Discussionsupporting

confidence: 90%

“…www.surveymonkey.com) and distributed to all members through the CORD listserv. The validity of using the CORD listserv as sample population has been described elsewhere 7,11,12. The responses were collected, and duplicated responses were removed and compiled for data analysis.…”

Section: Methodsmentioning

confidence: 99%

Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm

Lee¹,

Jordan²,

Hern³

et al. 2017

WestJEM

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“…We conducted a literature review of previous surveys done on ED handoffs and identified one study as a model 12. We based the first half of the survey questions on this study.…”

Section: Methodsmentioning

confidence: 99%

Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs

Heilman

Flanigan

Nelson

et al. 2016

WestJEM

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IntroductionAcademic emergency department (ED) handoffs are high-risk transfer of care events. Emergency medicine residents are inadequately trained to handle these vital transitions. We aimed to explore what modifications the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs.MethodsThis mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs. We conducted a literature review, focus groups, and then a survey. We sought to identify the distinctive elements of ED handoffs and discern how these could be incorporated into the I-PASS system.ResultsFocus group participants agreed the patient summary should be adapted to include anticipated disposition of patient. Participants generally endorsed the order and content of the other elements of the I-PASS tool. The survey yielded several wording changes to reflect contextual differences. Themes from all qualitative sources converged to suggest changes for brevity and clarity. Most participants agreed that the I-PASS tool would be well suited to the ED setting.ConclusionWith modifications for context, brevity, and clarity, the I-PASS system may be well suited for application to the ED setting. This study provides qualitative data in support of using the I-PASS tool and concrete suggestions for how to modify the I-PASS tool for the ED. Implementation and outcome research is needed to investigate if the I-PASS tool is feasible and improves patient outcomes in the ED environment.

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“…This task force included EM residency program directors (PDs), academic chairpersons, and other EM faculty. The survey content underwent a thorough development process . The expertise of those involved in the development of the survey contributed to the validity of its content .…”

Section: Methodsmentioning

confidence: 99%

“…The objectives of the survey study were to 1) assess the scope of current handoff practices amongst EM residents through the experience of their residency program director and/or other senior faculty and 2) to assess current educational and evaluation practices related to handoffs. The current survey is a follow‐up survey to our initial 2011 study of U.S. EM residencies . Given the ever‐increasing emphasis on transitions of care in medicine, we sought to determine if interval changes in resident transition of care education, assessment, and proficiency have occurred.…”

mentioning

confidence: 99%

Handoff Practices in Emergency Medicine: Are We Making Progress?

Hern

Gallahue

Burns

et al. 2016

Academic Emergency Medicine

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Objectives: Transitions of care present a risk for communication error and may adversely affect patient care. This study addresses the scope of current handoff practices amongst U.S. emergency medicine (EM) residents. In addition, it evaluates current educational and evaluation practices related to handoffs. Given the ever-increasing emphasis on transitions of care in medicine, we sought to determine if interval changes in resident transition of care education, assessment, and proficiency have occurred.Methods: This was a cross-sectional survey study guided by the Kern model for medical curriculum development. The Council of Residency Directors Listserv provided access to 175 programs. The survey focused on elucidating current practices of handoffs from emergency physicians (EPs) to EPs, including handoff location and duration, use of any assistive tools, and handoff documentation in the emergency department (ED) patient's medical record. Multiple-choice questions were the primary vehicle for the response process. A four-point Likert-type scale was used in questions regarding perceived satisfaction and competency. Respondents were not required to answer all questions. Responses were compared to results from a similar 2011 study for interval changes.Results: A total of 127 of 175 programs responded to the survey, making the overall response rate 72.6%. Over half of respondents (72 of 125, 57.6%) indicated that their ED uses a standardized handoff protocol, which is a significant increase from 43.2% in 2011 (p = 0.018). Of the programs that do have a standardized system, a majority (72 of 113, 63.7%) of resident physicians use it regularly. Significant increases were noted in the number of programs offering formal training during orientation (73.2% from 59.2%; p = 0.015), decreases in the number of programs offering no training (2.4% from 10.2%; p = 0.013), and no assessment of proficiency (51.5% from 69.8%; p = 0.006). No significant interval changes were noted in handoffs being documented in the patient's medical record (57.4%), the percentage of computer/electronic signouts, or the level of dissatisfaction with handoff tools (54.1%). Less than two-thirds of respondents (80 of 126, 63.5%) indicated that their residents were "competent" or "extremely competent" in delivering and receiving handoffs.Conclusions: An insufficient level of handoff training is currently mandated or available for EM residents, and their handoff skills appear to be developed mostly informally throughout residency training with varying results. Programs that have created a standardized protocol are not ensuring that the protocol is actually being employed in the clinical arena. Handoff proficiency most often goes unevaluated, although it is improved from 2011.ACADEMIC EMERGENCY MEDICINE 2016;23:197-201

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A Survey of Handoff Practices in Emergency Medicine

Cited by 10 publications

References 22 publications

Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm

Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm

Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs

Handoff Practices in Emergency Medicine: Are We Making Progress?

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