Interunit Handoffs of Patients and Transfers of Information: A Survey of Current Practices

Kessler, Chad; Scott, Nathaniel L.; Siedsma, M; Jordan, Jaime; Beach, Christopher; Coletti, Christian

doi:10.1016/j.annemergmed.2014.04.022

Cited by 37 publications

(39 citation statements)

References 23 publications

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“…Given the identified need for handoff education and existing literature, authors developed a handoff algorithm ‘Prep-4Cs.’8,15–18,30 The handoff algorithm consists of five steps (Table 3). …”

Section: Resultsmentioning

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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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: Resultsmentioning

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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“…In addition, ineffective handovers can cause major problems relating to lack of delivery of appropriate care and the possibility of misuse or poor utilisation of resources (Arora et al 2005, Siddiqui et al 2012). Previous survey studies of clinical handover have mainly focused on considering the perspectives of doctors (Fassett et al 2007, Karnwal et al 2008, Johner et al 2013, Lindsay et al 2013, Mazhar et al 2013, Kessler et al 2014 or nurses (O'Connell et al 2008, Street et al 2011. However, the delivery of high-quality clinical handovers often requires communication and collaboration between different health professions.…”

Section: Introductionmentioning

confidence: 99%

Perspectives of clinical handover processes: a multi‐site survey across different health professionals

Manias

Geddes

Watson

et al. 2015

Journal of Clinical Nursing

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Aims and objectives. To examine the perspectives of health professionals of different disciplines about clinical handover. Background. Ineffective handovers can cause major problems relating to the lack of delivery of appropriate care. Design. A prospective, cross-sectional design was conducted using a survey about clinical handover practices. Methods. Health professionals employed in public metropolitan hospitals, public rural hospitals and community health centres were involved. The sample comprised doctors, nurses and allied health professionals, including physiotherapists, social workers, pharmacists, dieticians and midwives employed in Western Aus-tralia, New South Wales, South Australia and the Australian Capital Territory. The survey sought information about health professionals' experiences about clinical handover; their perceived effectiveness of clinical handover; involvement of patients and family members; health professionals' ability to confirm understanding and to clarify clinical information; role modelling behaviour of health professionals ; training needs; adverse events encountered and possibilities for improvements. Results. In all, 707 health professionals participated (response rate = 14%). Represented professions were nursing (60%), medicine (22%) and allied health (18%). Many health professionals reported being aware of adverse events where they noticed poor handover was a significant cause. Differences existed between health professions in terms of how effectively they gave handover, perceived effectiveness of bedside handover vs. nonbedside handover, patient and family involvement in handover, respondents' confirmation of understanding handover from their perspective, their observation of senior health professionals giving feedback to junior health professionals, awareness of adverse events and severity of adverse events relating to poor handovers. What does this study contribute to the wider global clinical community? • No previous published survey research has involved an exploration of perceptions and experiences of health professionals of multiple disciplines in relation to clinical handover. In this exploratory study, we examined the perceptions and experiences of health professionals of different disciplines about clinical handover, comprising doctors, nurses and allied health professionals, including physiotherapists , social workers, dieticians, pharmacists and midwives. • Despite extensive measures available worldwide aimed at improving clinical handover processes, participating health professionals experienced adverse events relating to clinical handover in seven areas. These were: delays in treatment or procedure, or, prolonged treatment or procedure; lack of monitoring information given on clinical assessment, leading to patient deterioration; errors involving medications; patient falls; disruptive, aggressive behaviour and confused state leading to injury; putting patients at risk of infection and putting infants at risk. Greater levels of innovation are needed in training a...

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“…Regardless, the absolute prevalence of handoff omission errors by resident physicians confirms results from a recent survey suggesting handoff standardization or education as a significant gap in emergency medicine training. 7 Our failure to find a relationship between ED crowding and other communication behaviors and handoff errors suggests that providers likely use various strategies to compensate for the challenging ED environment. For example, unmeasured factors such as team-based communication, ad hoc use of handoff checklists, resident review of the electronic medical record before rounds, contemporaneous review of the electronic medical record by providers during rounds, and the colocation of nursing and physician staff were all unmeasured in this study but observed by research assistants to improve handoff communication.…”

Section: Discussionmentioning

confidence: 92%

“…3 A recent survey reported a dearth of formal handoff training and proficiency among emergency medicine residency programs, and the only direct observation of ED handoffs conducted to our knowledge demonstrated errors in 13% and omissions in 45% of handoffs. 7,8 Importance…”

Section: Introduction Backgroundmentioning

confidence: 99%

Communication of Vital Signs at Emergency Department Handoff: Opportunities for Improvement

Venkatesh

Curley

Chang

et al. 2015

Annals of Emergency Medicine

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Interunit Handoffs of Patients and Transfers of Information: A Survey of Current Practices

Cited by 37 publications

References 23 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

Perspectives of clinical handover processes: a multi‐site survey across different health professionals

Communication of Vital Signs at Emergency Department Handoff: Opportunities for Improvement

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