A potential weak link in patient safety: ER to inpatient handoffs

Physicians say that patient safety is often at risk because of ineffective communication during the emergency department (ED) handoff process when patients are moved to inpatient units.

That's the findings from a University of Nebraska Medical Center study published in the Journal of Hospital Medicine. Researchers say the findings support the need for collaborative efforts to improve communication between physicians during the handoff process from the ED to inpatient units, according to a study announcement.

As part of the 627-bed medical center's effort to improve its own handoff process, Christopher J. Smith, M.D., and colleagues surveyed 94 admitting physicians from five inpatient medical services and 32 emergency medicine physicians about their perceptions of the process and barriers to safe patient care.

The survey, which included resident, fellow and faculty physicians, found major differences between the two groups. For instance, admitting physicians reported that vital clinical information was not communicated frequently when compared to ED physicians. Admitting physicians also reported worse quality of communication and less confidence in the handoff system's ability to ensure patient safety.

There was also disconnect between the two groups. Ninety-four percent of the ED physicians reported feeling they had to defend their clinical decision at least "sometimes." And that feeling that admitting physicians did not trust their clinical judgments was supported by the fact that more than 25 percent of admitting physicians said they usually disagreed with decisions made in the ED. Just under one-third of all respondents reported handoff-related adverse events, most frequently blamed on ineffective communication. Sequential handoffs were common for both ED and admitting services, with 78 percent of physicians reporting they negatively impact patient care.

Based on the survey, the Nebraska medical center is pilot-testing a standardized approach for ED-to-hospital handoffs and plans to re-survey physicians after its implementation.

Researchers believe the organizatin can improve the process by training residents how to perform handoffs, asking for more direct involvement of attending physicians and increasing face-to-face communication.

Prior research supports the need for improved communication between physicians during patient handoffs. One study of a resident handoff-improvement program in nine hospitals found a reduction in medical errors and preventable adverse events. A standardized handoff process also reduced errors in 23 pediatric hospitals.

To learn more:
- Here's the study abstract
- read the announcement

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