Internal and Emergency Medicine

, Volume 13, Issue 3, pp 385–395 | Cite as

Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine

  • Kamna S. BalharaEmail author
  • Susan M. Peterson
  • Mohamed Moheb Elabd
  • Linda Regan
  • Xavier Anton
  • Basil Ali Al-Natour
  • Yu-Hsiang Hsieh
  • James Scheulen
  • Sarah A. Stewart de Ramirez


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.


Clinical 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.

Informed consent

Participants provided written consent.


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Copyright information

© SIMI 2017

Authors and Affiliations

  • Kamna S. Balhara
    • 1
    Email author
  • Susan M. Peterson
    • 2
  • Mohamed Moheb Elabd
    • 3
  • Linda Regan
    • 2
  • Xavier Anton
    • 3
  • Basil Ali Al-Natour
    • 3
  • Yu-Hsiang Hsieh
    • 2
  • James Scheulen
    • 2
  • Sarah A. Stewart de Ramirez
    • 2
  1. 1.Department of Emergency MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  2. 2.Department of Emergency MedicineJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of Emergency MedicineAl Rahba HospitalAbu DhabiUnited Arab Emirates

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