Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine
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Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9–13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.
KeywordsClinical handoff Emergency service, hospital Patient admission Inter-unit communication
Compliance with ethical standards
Conflict of interest
The Authors declare that they have no conflict of interest.
Statement of human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Participants provided written consent.
- 6.JCAHO (2005) JCAHO’s 2006 national patient safety goals: Handoffs are biggest challenge. Hosp Peer Rev 30(7):89–93Google Scholar
- 7.Joint Commission (2006) National Patient Safety Goals, 2006, Critical access hospital and hospital national patient safety goals. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/06_npsg_cah.htm. Accessed Dec 2015
- 8.Petersen LA, Orav EJ, Teich JM et al (1997) Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Commun J Qual Improv 24(2):77–87Google Scholar
- 19.Joint Commission International Accreditation Standards for Hospitals (2013) 5th edition. http://www.jointcommissioninternational.org/assets/3/7/Hospital-5E-Standards-Only-Mar2014.pdf. Accessed January 2016
- 20.Joint Commission Center for Transforming Healthcare (2016) Facts about the Hand-off Communications Project. http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf. Accessed Mar 2016
- 24.Going Lean in Health Care (2005) IHI Innovation Series white paper. Institute for Healthcare Improvement, Cambridge. http://www.IHI.org. Accessed Dec 2015
- 29.Joint Commission on Accreditation of Healthcare Organizations (2007) National Patient Safety Goals Hospital Version Manual Chapter. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_hap_cah_npsgs.thm. Accessed Dec 2015
- 31.Perry SJ, Wears RL, Patterson ES (2008) High-hanging fruit: improving transitions in health care. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches, vol 3: performance and tools. Agency for Healthcare Research and Quality (US), RockvilleGoogle Scholar
- 33.Kerr D, McKay K, Klim S et al (2015) Attitudes of emergency department patients about handover at the bedside. J Clin Nurs 23(11–12):1685–1693Google Scholar
- 34.Sheth S, McCarthy E, Kipps AK et al (2016) Changes in efficiency and safety culture after integration of an I-PASS-supported handoff process. Pediatrics 136(2):1–9Google Scholar
- 35.Federal Aviation Administration (2008) Section 12: Aircraft Checklists for 14 CFR Parts 121/135.https://www.faa.gov/regulations_policies/handbooks_manuals/aircraft/amt_handbook/media/FAA-8083-30_Ch12.pdf. Accessed Dec 2015