Dropping the Baton: A Qualitative Analysis of Failures During the Transition From Emergency Department to Inpatient Care

Horwitz, Leora I.; Meredith, Thom; Schuur, Jeremiah D.; Shah, Nidhi; Kulkarni, Raghavendra G.; Jenq, Grace

doi:10.1016/j.annemergmed.2008.05.007

Cited by 256 publications

(250 citation statements)

References 38 publications

Supporting

Mentioning

245

Contrasting

Unclassified

Order By: Relevance

“…We conducted interviews using a discussion guide (see online Appendix) that explores experiences and perspectives towards quality and safety in the discharge process and was informed by recent qualitative studies of residents' perspectives on other quality and safety practices. 13,14,20 Interviews were conducted in June 2010 and January 2011 to sample resident perspectives at two different points in time. Participants were entered into a lottery for one of three $100 gift cards at each site as an incentive to participate.…”

Section: Study Design and Samplementioning

confidence: 99%

“…10 Recent duty hour regulations 11,12 have also heightened these challenges and drawn increased attention to transitions of care at teaching hospitals. 13 Although studies of inpatient transitions, such emergency departmentto-floor 14 or dayshift-to-nightshift handoff practices for inpatient units, 15,16 have already informed curricular changes at residency programs, 17 we have very limited data about resident practices at the point of discharge. Recently, we described quality-limiting factors in discharge care at teaching hospitals; however, information is still lacking about how residents learn to provide high-quality discharge care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

et al. 2012

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Reducing readmissions and post-discharge adverse events by improving the quality of discharge care has become a national priority, yet we have limited understanding about how physicians learn to provide high-quality discharge care. METHODS: We conducted in-depth, in-person interviews with housestaff physicians with qualitative analysis by a multi-disciplinary team using the constant comparative method to explore learning about highquality discharge care as a systems-based practice and to identify opportunities to improve training around these concepts. RESULTS: We analyzed interview transcripts from 29 internal medicine residents: 17 (59 %) were interns (PGY-2 or PGY-3), 12 (41 %) seniors, and 17 (59 %) were female. We identified a recurrent theme of lack of formal training about the discharge process, substantial peerto-peer instruction, and "learning by doing" on the wards. Within this theme, we identified five specific concepts related to systems-based practice and highquality discharge care which residents learned during residency: (1) teamwork and the interdisciplinary nature of discharge planning; (2) advanced planning strategies to anticipate challenges in the discharge process; (3) patient safety and the concept of a "safe discharge;" (4) patient continuity of care and learning from post-discharge outcomes and; (5) documentation of discharge plans as a valuable skill. CONCLUSIONS: Discharge care is an overlooked opportunity to teach concepts of systems-based practice explicitly as learning about discharge care is unstructured and individual experiences may vary considerably. Educational interventions to standardize learning about discharge care may improve the development of systems-based practice during residency and help improve the overall quality of discharge care at teaching hospitals.KEY WORDS: discharge care; quality of care; core competencies; residency education.

show abstract

Section: Study Design and Samplementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…There has been less research investigating handover across organisations, 59,60 although this is starting to change. This area is of particular importance because of cultural differences, often high levels of uncertainty and absence of clear diagnosis, pending test and investigation results creating opportunities for omission, and the more vulnerable state of the patient, for whom delays or other handover failures may have serious consequences.…”

Section: Handover Across Boundaries Is Of Particular Importance In Emmentioning

confidence: 99%

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

Sujan

Spurgeon

Inada-Kim

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available. Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). PublisherEditorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: www.netscc.ac.uk/hsdr/ This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its proceeding programmes as project number 10/1007/26. The contractual start date was in April 2011. The final report began editorial review in January 2013 and was accepted for publication in May 2013. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, th...

show abstract

“…Horwitz et al 5 found that 29% of provider survey respondents had a patient of theirs experience an adverse event or near miss after an ED to inpatient transfer of care. Non-EM residents in training have been studied and, although recognizing other factors that may lead to errors, often perceive the ED as responsible for error.…”

Section: Resultsmentioning

confidence: 99%

Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department

Smith¹,

Burris²,

Mahmoud³

et al. 2011

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Background The Accreditation Council for Graduate Medical Education requirements for systems-based practice state residents are expected to participate in identifying system errors and implementing potential systems solutions. The objective of this study was to determine the numbers of perceived errors occurring from patient pass offs between resident physicians in our emergency department. Methods Using a prospective observational study, we queried emergency medicine residents about perceived errors in the transition of care using trained research assistants and a standardized protocol. Transition of care was defined as the transfer of responsibility to evaluate and treat and disposition of a patient in the emergency department from 1 resident physician to a second oncoming emergency department resident physician. Mean resident-perceived errors per shift and per patient transfer of care were calculated. Additionally, the mean number of perceived errors impacting patients was calculated. Results Emergency medicine residents on 107 shifts reported receiving 713 patients in pass off with a mean of 7 patients per physician per shift, with 40% of patients passed off needing some intervention (mean of 2.8 patients per provider per shift). Nineteen of the 107 shifts (17.8%) during which a resident took patients from a prior provider had a perceived error in at least 1 patient signed off. Of the 713 patients transitioned, the receiving physician perceived an error related to the transition of care for 23. Two of the 23 errors were determined by reviewing emergency medicine attendings to not be errors, and for 9 the receiving physician perceived an impact on the patient. All were delays in care or disposition. Conclusion Our data suggest emergency medicine residents were able to perceive errors related to transitions of care, describe the types of pass-off errors, and, to a lesser degree, describe the impact these errors have on patients.

show abstract

Dropping the Baton: A Qualitative Analysis of Failures During the Transition From Emergency Department to Inpatient Care

Cited by 256 publications

References 38 publications

“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department

Contact Info

Product

Resources

About