Handoffs: Transitions of Care for Children in the Emergency Department

Shook, Joan E.; Chun, Thomas H.; Conners, Gregory P.; Conway, Edward E.; Dudley, Nanette C.; Fuchs, Susan; Lane, Natalie; Macias, Charles G.; Moore, Brian R.; Wright, Joseph L.; Benjamin, Lee S.; Barata, Isabel A.; Alade, Kiyetta; Arms, Joseph; Avarello, Jahn T.; Baldwin, Steven; Brown, Kathleen M.; Cantor, Richard M.; Cohen, Ariel; Dietrich, Ann; Eakin, Paul J.; Gausche‐Hill, Marianne; Gerardi, Michael; Graham, Charles J.; Holtzman, Doug K.; Hom, Jeffrey; Ishimine, Paul; Jinivizian, Hasmig; Joseph, Madeline; Mehta, Sanjay; Ojo, Aderonke; Paul, Audrey; Pauze, Denis R.; Pearson, Nadia M.; Rosen, Brett; Russell, W. Scott; Saidinejad, Mohsen; Sloas, Harold A.; Schwartz, Gerald R.; Swenson, Orel; Valente, Jonathan H.; Waseem, Muhammad; Whiteman, Paula J.; Woolridge, Dale; Goodman, Robin; Johnson, Rose; Frankenberger, Warren D.; Johnson, Mindi; Zinkan, J. Lynn; Martin, Heather; Milici, Justin; Young, Tiffany

doi:10.1542/peds.2016-2680

Cited by 42 publications

(6 citation statements)

References 68 publications

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“…This may be particularly true in the ambulatory setting, where communication is typically asynchronous between geographically dispersed providers of different disciplines and clinical contexts. Ensuring the quality and safety of transitions between ambulatory care and acute care, whether the Emergency Department (ED) or hospital, has been recognized as a shared responsibility [46]. Clear communication between ED and the medical home is particularly critical when there are pending tests or the child has complex medical needs [46].…”

Section: Errors Related To Care Coordination and Care Transitionsmentioning

confidence: 99%

“…Ensuring the quality and safety of transitions between ambulatory care and acute care, whether the Emergency Department (ED) or hospital, has been recognized as a shared responsibility [46]. Clear communication between ED and the medical home is particularly critical when there are pending tests or the child has complex medical needs [46]. Challenges have been described with written and verbal communication between providers in the ambulatory and inpatient setting, with conflicting expectations for roles and responsibilities [47].…”

Section: Errors Related To Care Coordination and Care Transitionsmentioning

confidence: 99%

“…Clinicians have been called to engage in a structured and consistent approach to communication during transitions in care [46]. Bundled handoff interventions have been associated with reductions in medical error and preventable adverse events in the inpatient setting [50].…”

Section: Strategies To Support Care Coordination and Care Transitionsmentioning

confidence: 99%

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Patient Safety in Ambulatory Pediatrics

Huth

Hotz

Starmer

2020

Curr Treat Options Peds

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Purpose of Review The majority of patient care occurs in the ambulatory setting, and pediatric patients are at high risk of medical error and harm. Prior studies have described various safety threats in ambulatory pediatrics, and little is known about effective strategies to minimize error. The purpose of this review is to identify best practices for optimizing safety in ambulatory pediatrics. Recent Findings The majority of the patient safety literature in ambulatory pediatrics describes frequencies and types of medical errors. Study of effective interventions to reduce error, and particularly to reduce harm, have been limited. There is evidence that medical complexity and social context are important modifiers of risk. Telemedicine has emerged as a care delivery model with potential to ameliorate and exacerbate safety threats. Though there is variation across studies, developing a safety culture, partnerships with patients and families, and use of structured communication are strategies that support patient safety. Summary There is no standardized taxonomy for errors in ambulatory pediatrics, but errors related to medications, vaccines, diagnosis, and care coordination and care transitions are commonly described. Evidence-based approaches to optimize safety include standardized prescribing and medication reconciliation practices, appropriate use of decision support tools in the electronic health record, and communication strategies like teach-back. Further high-quality intervention studies in pediatric ambulatory care that assess impact on patient harm and clinical outcomes should be prioritized. Patient Safety (Ma Coffey, Section Editor) Medication errors Wrong drug prescribed or administered Wrong dose prescribed or administered Wrong route prescribed or administered Wrong frequency or duration prescribed or administered Omitted or duplicated dose Drug-drug interaction Known allergy Vaccine errors Wrong timing of vaccine Wrong route of administration Storage and dispensing errors Wrong vaccine administered Diagnostic errors Errors in the evaluation of signs and symptoms Errors in follow-up of diagnostic tests Errors related to missed, incorrect or delayed diagnoses Misfiled or erroneously entered patient information Lack of consent for an adult accompanying a child Delay in office care Wrong patient registered or treated Care coordination and care transition errors Verbal or written handoff communication failure Coordination errors including delayed access to medications, medical equipment and supplies Patient Safety in Ambulatory Pediatrics Huth et al.

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Section: Errors Related To Care Coordination and Care Transitionsmentioning

confidence: 99%

Section: Errors Related To Care Coordination and Care Transitionsmentioning

confidence: 99%

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Patient Safety in Ambulatory Pediatrics

Huth

Hotz

Starmer

2020

Curr Treat Options Peds

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“…Research on the use of ICT to support care transitions is predicted to grow rapidly as patients and clients increasingly demonstrate preferences for the use of these technologies in their care [ 17 ]. Health care providers also recommend better and more appropriate use of ICT to support families in self-managing care at home [ 18 ]. Despite the communication challenges faced by families during this transition point, strain on existing ED resources and the lack of standards and implementation guidelines remain significant barriers to the widespread adoption of electronic discharge communication tools (EDCTs) in pediatric emergency contexts.…”

Section: Introductionmentioning

confidence: 99%

Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review

Wozney¹,

Curran²,

Archambault³

et al. 2022

JMIR Pediatr Parent

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Background Electronic discharge communication tools (EDCTs) are increasingly common in pediatric emergency departments (EDs). These tools have been shown to improve patient-centered communication, support postdischarge care at home, and reduce unnecessary return visits to the ED. Objective This study aimed to map and assess the evidence base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features, and outcomes. Methods A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. A total of 7 databases (EBSCO, MEDLINE, CINAHL, PsycINFO, EMBASE Scopus, and Web of Science) were searched for studies published between 1989 and 2021. Studies evaluating discharge communication–related outcomes using electronic tools (eg, text messages, videos, and kiosks) in pediatric EDs were included. In all, 2 researchers independently assessed the eligibility. Extracted data related to study identification, methodology, settings and demographics, intervention features, outcome implementation features, and practice, policy, and research implications. The Mixed Method Appraisal Tool was used to assess methodological quality. The synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics, and heat mapping. Results In total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. In all, 70% (26/37) of the studies met at least three of five Mixed Method Appraisal Tool criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. The time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (eg, asthma, fracture, head injury, fever, and otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service use. Unvalidated self-report measures were typically used for measurement. Health care provider satisfaction or system-level impacts were infrequently measured in studies. The directionality of primary outcomes pointed to positive effects for the primary measure (44/55, 80%) or no significant difference (10/55, 18%). Only one study reported negative findings, with an increase in return visits to the ED after receiving the intervention compared with the control group. Conclusions This review is the first to map the broad literature of EDCTs used in pediatric EDs. The findings suggest a promising evidence base, demonstrating that EDCTs have been successfully integrated across clinical contexts and deployed via diverse technological modalities. Although caregiver and patient satisfaction with EDCTs is high, future research should use robust trials using consistent measures of communication quality, clinician experience, cost-effectiveness, and health service use to accumulate evidence regarding these outcomes. Trial Registration PROSPERO CRD42020157500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157500

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“…In the urgent care and emergency field, the link between two levels of care for critically ill patients is called handover or handoff [5][6][7][8][9]. This is defined as the process that occurs when responsibility for the care of a patient is transferred from one critical patient care healthcare team to another, requiring the accurate delivery of information [10]. There are two types of transfer: temporary (shift change) and definitive (change of unit or level of care, or inter-hospital transfer) [11].…”

Section: Introductionmentioning

confidence: 99%

Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools

Tortosa-Alted

Martínez-Segura

Berenguer‐Poblet

et al. 2021

JCM

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The emergency handover of critical patients is used to describe the moment when responsibility for the care of a patient is transferred from one critical patient care healthcare team to another, requiring the accurate delivery of information. However, the literature provides few validated assessment tools for the transfer of critical patients in urgent care and emergency settings. To identify the available evaluation tools that assess the handover of critical patients in urgent and emergency care settings in addition to evaluations of their psychometric properties, a systematic review was carried out using PubMed, Scopus, Cinahl, Web of Science (WoS), and PsycINFO, in accordance with PRISMA guidelines. The quality of the studies was assessed using the COSMIN checklist. Finally, eight articles were identified, of which only three included validated tools for evaluating the handover of critical patients in emergency care. Content validity, construct validity, and internal consistency were the most studied psychometric properties. Three studies evaluated error and reliability, criterion validity, hypothesis testing, and sensitivity. None of them considered cross-cultural adaptation or the translation process. This systematic psychometric review shows the existing ambiguities in the handover of critically ill patients and the scarcity of validated evaluation tools. For all of these reasons, we consider it necessary to further investigate urgent care and emergency handover settings through the design and validation of an assessment tool.

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Handoffs: Transitions of Care for Children in the Emergency Department

Cited by 42 publications

References 68 publications

Patient Safety in Ambulatory Pediatrics

Patient Safety in Ambulatory Pediatrics

Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review

Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools

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