Handoff Practices in Emergency Medicine: Are We Making Progress?

Hern, H. Gene; Gallahue, Fiona E.; Burns, B.; Druck, Jeffrey; Jones, Jonathan Spencer; Kessler, Chad; Knapp, Barry; Williams, Sarah R.

doi:10.1111/acem.12867

Cited by 18 publications

(15 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 7 8 The CORD survey showed that over half of the respondents from academic EDs indicated that their EDs use a standardized handoff. 9 However, it is not known how emergency medicine (EM) residency programs are providing training around care transitions from the ED to inpatient settings.…”

Section: Introductionmentioning

confidence: 99%

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

Lee¹,

Jordan²,

Hern³

et al. 2017

WestJEM

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Lee¹,

Jordan²,

Hern³

et al. 2017

WestJEM

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a recent study by Hern et al, 57% of residency programs had curriculum focused on transitions of care. Hern et al recently found 57% of residency programs have curriculum focused on handoffs, a much higher percentage than PE 12. Another study found 93% of residency programs had curriculum focused on operations and administration.…”

Section: Discussionmentioning

confidence: 99%

Teaching the Emergency Department Patient Experience: Needs Assessment from the CORD-EM Task Force

London¹,

Druck

Silver³

et al. 2017

WestJEM

Self Cite

View full text Add to dashboard Cite

IntroductionSince the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies.MethodsThis was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide.ResultsWe obtained 168 responses from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third-party attending data on cases with resident participation, 37% provide third-party acquired data specifically about residents and 37% provide internally acquired quantitative data.Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities; 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions.ConclusionThe majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do use a heterogeneous set of data collection modalities and educational techniques. American Osteopathic Association and Accreditation Council for Graduate Medical Education residencies show no significant differences in their resident PS data provision or formal curricula. Further work is needed to improve education given the high stakes of PS scores in the emergency physician’s career.

show abstract

“…Communication miscues and omissions, the most frequently numerated barrier to efective patient transition of care [17], correspond with the lack of consensus about the elements of efective handof [2]. Substantial variability exists across, and sometimes within, institutions regarding preferred formats and processes for verbal and writen handofs.…”

Section: Barriers To Efective Handofsmentioning

confidence: 99%

“…Substantial variability exists across, and sometimes within, institutions regarding preferred formats and processes for verbal and writen handofs. Research of residency training programs nationally indicate that handof standardization has not been aggressively implemented and evaluated among residency training programs or implemented with variable compliance [2,18].…”

Section: Barriers To Efective Handofsmentioning

confidence: 99%

See 1 more Smart Citation

Transitions of Care: Complications and Solutions

Salen¹

2017

Vignettes in Patient Safety - Volume 1

View full text Add to dashboard Cite

The delivery of medical care relies on efective, succinct, and ongoing communication between healthcare providers, called handofs. Handofs involve the transfer of professional responsibility and accountability for aspects of care for patients to another clinician or clinical team on a temporary or permanent basis. Handofs have the potential for deleterious clinical impact if inadequately done. Only recently has data become available that demonstrate improvements in handofs reduce the rate of subsequent clinical care error. This clinical vignete and subsequent discussion focuses on physician, particularly the resident physician in training, transfer of care: handof complications, barriers to efective handofs, regulatory agencies' input on handof improvement, standardization of the handof process, assessment of the quality of handof, handof error avoidance, and improving the quality of handof.

show abstract

Handoff Practices in Emergency Medicine: Are We Making Progress?

Cited by 18 publications

References 26 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

Teaching the Emergency Department Patient Experience: Needs Assessment from the CORD-EM Task Force

Transitions of Care: Complications and Solutions

Contact Info

Product

Resources

About