Improving Handoffs in the Emergency Department

Cheung, Dickson; Kelly, John; Beach, Christopher; Berkeley, Ross P.; Bitterman, Robert A.; Broida, Robert I.; Dalsey, William C.; Farley, Heather; Fuller, Drew C.; Garvey, D.; Klauer, Kevin; McCullough, Lynne; Patterson, Emily S.; Pham, Julius Cuong; Phelan, Michael; Pines, Jesse M.; Schenkel, Stephen M.; Tomolo, Anne; Turbiak, T; Vozenilek, John A.; Wears, Robert L.; White, Marjorie Lee

doi:10.1016/j.annemergmed.2009.07.016

Cited by 211 publications

(155 citation statements)

References 36 publications

Supporting

Mentioning

149

Contrasting

Unclassified

Order By: Relevance

“…One particular concern is transitions in care from the emergency department (ED) to the academic internal medicine (AIM) service. The importance of transitions in care and communication is elucidated in the literature [1] and is underscored by the Milestones Assessment of the American College of Graduate Medical Education (ACGME). In order to graduate from residency, a resident needs to be able to: “Appropriately utilize available resources to coordinate care and ensures safe and effective patient care within and across delivery systems;” as well as “proactively communicates with past and future caregivers to ensure continuity of care” (Milestone 11) [2].…”

Section: Introductionmentioning

confidence: 99%

Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service

Fung

Hyde

Davis

2018

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots. We found a significant improvement in ED and AIM provider satisfaction with the admission process. There was also a significant increase in admissions to the AIM service after implementation of the app. We submit that the implementation of a mobile app is a viable, cost-efficient, and effective method to streamline the admission process from the ED to AIM services at community-based hospitals.

show abstract

Section: Introductionmentioning

confidence: 99%

Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service

Fung

Hyde

Davis

2018

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

“…The ED doctor (sender) provides a short descriptive monologue outlining the patient's current status (rows 1-7). The receiving acute medicine doctor (receiver) then takes the lead in the conversation and strongly guides the ED doctor (sender) in articulating the reason for admission (rows [16][17][18][19][20][21][22][23][24][25]. The receiving doctor then attempts to summarise this and seeks confirmation (rows 26-27).…”

Section: Language Forms and Patterns Of Interactionmentioning

confidence: 99%

Emergency Care Handover (Echo Study) Across Care Boundaries–the Need for Joint Decision-Making and Consideration of Psychosocial History

et al. 2013

View full text Add to dashboard Cite

Background Inadequate handover in emergency care is a threat to patient safety. Handover across care boundaries poses particular problems due to different professional, organisational and cultural backgrounds. While there have been many suggestions for standardisation of handover content, relatively little is known about the verbal behaviours that shape handover conversations. This paper explores both what is communicated (content) and how this is communicated (verbal behaviours) during different types of handover conversations across care boundaries in emergency care. Methods Three types of interorganisational (ambulance service to emergency department (ED) in 'resuscitation' and 'majors' areas) and interdepartmental handover conversations (referrals to acute medicine) were audio recorded in three National Health Service EDs. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis. Results 203 handover conversations were analysed. Handover conversations involving ambulance services were predominantly descriptive (60%-65% of utterances), unidirectional and focused on patient presentation (75%-80%). Referrals entailed more collaborative talk focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%-5% of handover conversation content related to the patient's social and psychological needs. Conclusions Handover may entail both descriptive talk aimed at information transfer and collaborative talk aimed at joint decision-making. Standardisation of handover needs to accommodate collaborative aspects and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.

show abstract

“…and exceeds simplistic standardization solutions for erring, advancing to error prevention and recovery [34]. For example, while standardization views such events as handover, or medication administration as vulnerable points of care that can pose threats to patient safety, the resilience approach recognizes that these crucial encounters provide an important "audit-point" essential for potential recovery from failure [14,30,33,35,36]. Communication at the handover can also furnish new perspectives on a patient's situation as a result of the outgoing party's renewed attention to it while preparing for the handover, or of the incoming party's "fresh perspective and a rested mind" [29].…”

Section: Focus Characteristics Advantages Drawbacksmentioning

confidence: 99%

From Standardization to Resilience: How Day-To-Day Life in Healthcare Organizations Shapes Safety

Drach‐Zahavy

Somech²

2014

Occup Med Health Aff

View full text Add to dashboard Cite

This paper focuses on the working strategies nurses develop and employ in their day-to-day routine in an attempt to identify "red alerts" which enable them to maintain patient safety despite the load and interruptions characterizing their work environment. Based on insights gained from three studies (focusing on nurses' medication administration, use of protective measures and transferring information during handover) we develop a theoretical model that describes how understanding aspects of the day-to-day life in healthcare organizations, and the system of meaning that guides everyday life, can inform our understanding of workplace safety. The model illustrates how the chaotic, turbulent, and complex environment characterizing the nurses' workplace prevents them from fully complying with the declared safety goals practices and procedures. Yet even under these near-impossible circumstances, the nurses' main mission is to maintain patients' safety. Embracing a resilience strategy allows nurses to actively prevent something bad from happening or becoming worse, and to repair something bad once it has occurred, which of course contribute to patient's safety. Otherwise, nurses might rely on an implicit theories strategy, limiting the likelihood that they will discover their misperceptions, thereby putting patients' safety at risk. The model further describes how each of these two strategies is reinforced by positive feedback loops on the individual, ward, and organizational levels. Practical implications for managers include work practices that can encourage nurses' resilience by creating a work environment of professionalism, mindfulness and awareness of errors.

show abstract

Improving Handoffs in the Emergency Department

Cited by 211 publications

References 36 publications

Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service

Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service

Emergency Care Handover (Echo Study) Across Care Boundaries–the Need for Joint Decision-Making and Consideration of Psychosocial History

From Standardization to Resilience: How Day-To-Day Life in Healthcare Organizations Shapes Safety

Contact Info

Product

Resources

About