Standardized Reporting System Use During Handoffs Reduces Patient Length of Stay in the Emergency Department

Abstract

BackgroundEmergency department (ED) shift handoffs are potential sources of delay in care. We aimed to determine the impact that using standardized reporting tool and process may have on throughput metrics for patients undergoing a transition of care at shift change.MethodsWe performed a prospective, pre- and post-intervention quality improvement study from September 1 to November 30, 2015. A handoff procedure intervention, including a mandatory workshop and personnel training on a standard reporting system template, was implemented. The primary endpoint was patient length of stay (LOS). A comparative analysis of differences between patient LOS and various handoff communication methods were assessed pre- and post-intervention. Communication methods were entered a multivariable logistic regression model independently as risk factors for patient LOS.ResultsThe final analysis included 1,006 patients, with 327 comprising the pre-intervention and 679 comprising the post-intervention populations. Bedside rounding occurred 45% of the time without a standard reporting during pre-intervention and increased to 85% of the time with the use of a standard reporting system in the post-intervention period (P < 0.001). Provider time (provider-initiated care to patient care completed) in the pre-intervention period averaged 297 min, but decreased to 265 min in the post-intervention period (P < 0.001). After adjusting for other communication methods, the use of a standard reporting system during handoff was associated with shortened ED LOS (OR = 0.60, 95% CI 0.40 - 0.90, P < 0.05).ConclusionsStandard reporting system use during emergency physician handoffs at shift change improves ED throughput efficiency and is associated with shorter ED LOS.

Impact of a standardized admissions process using a nurse intermediary

“…[5,6] Other standardized approaches using computerized or electronic handoff tools have also been suggested and utilized. [7,8] The ANC process included a standardized admission template that utilized a secure, electronic texting system. This standardized template served the dual purpose of clearly signaling the beginning of the admissions process, providing consistent information to the inpatient team, and allowing the ANC to simultaneously begin locating an appropriate bed for the patient.…”

“…[11] Dahlquist et al demonstrated a statistically significant reduction in ED length-of-stay from 311minutes to 263 minutes (p < .05). [8] Additionally, direct, rather than consultative admission models have been shown to be more efficient with regards to ED turnaround times. [14] The ANC admission process showed similar gains in process efficiency and patient flow, as the time-to-departure for patients admitted to an inpatient medical team was reduced.…”

“…[5,6] Other standardized approaches using computerized or electronic handoff tools have also been suggested and utilized. [7,8] The process for patients being admitted to Internal Medicine (IM) from the ED within an urban, academic hospital in Philadelphia was the same for over a decade (see Figure 1). That process involved an intermediary IM attending physician or senior resident "triager" who was responsible for taking a telephone call from the admitting team in the ED and subsequently transferring that information to the accepting IM team.…”

Der Zusammenhang zwischen Sicherheitskultur und Burnout-Risiko: Eine Befragung nicht-ärztlicher Mitarbeiter im Rettungsdienst

“…Dabei können beispielsweise verbesserte Arbeitsprozesse im Zusammenhang mit Schichtwechseln und Übergaben transparenter und effizienter gestaltet werden. Dies kann unter anderem durch standardisierte Berichtssysteme und strukturierte Übergaben erfolgen, um den Verlust von Informationen zu verhindern sowie die Effizienz der Behandlung zu verbessern [42]. Zudem muss die Wertschätzung und Zusammenarbeit, Integration und Koordination der Teamarbeit zwischen den einzelnen Einrichtungen gestärkt sowie die gerechte Fehlerkultur implementiert und mittels Schulungskonzepten trainiert werden [43].…”

Reducing Handoffs and Improving Patient Flow in the ED

“…This results in ED overcrowding, increasing the chances of medical errors, patient wait times, patient length of stay, and mortality. Similarly, handoffs also increase the chances of medical errors, length of stay and have other negative impacts on patient safety (Dahlquist et al 2018;Maughan et al 2011). Although researchers have focused on addressing the negative impact of overcrowding on patient safety, very few have focused on addressing the impact of ED handoffs on patient safety.…”