Patient Care Transitions From the ED to the Medicine Ward
Objective. To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period.
Design. Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation.
Setting. University-based, tertiary-care hospital.
Participants. Internal medicine resident physicians admitting patients from the emergency department.
Intervention. An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers.
Main outcome measures. (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events.
Results. Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality.
Conclusions. The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.
Successful and efficient communication of clinical information and transfer of responsibility between healthcare providers, also known as a 'handoff,' is vital for patient safety. Communication breakdowns can result in ineffective handoffs and are associated with adverse events, medical errors and patient safety risks. As a result, regulatory agencies, accrediting organizations and educators have increased focus on handoffs, calling for interventions aimed at improving the safety and effectiveness of handoffs to optimize patient care delivery.
Although handoffs between providers of the same service have been well studied, handoffs of patients transferred from one unit or specialty to another have not been well investigated. Such handoffs may be particularly vulnerable to breakdowns in the communication (or 'signout') process. In particular, patient transfers from the emergency department (ED) to medicine ward frequently involve clinical uncertainty and high acuity, which, along with cultural differences between services, can result in communication failures and insufficient information exchange at a critical stage in a patient's course. New handoff approaches using the current technology-enhanced health care environment to incorporate standardized electronic platforms for information exchange have potential to support safe and efficient between-unit transfers. To our knowledge, no work has investigated the perceived safety of an electronic handoff platform that does not require verbal communication between providers.
Our hospital implemented a new electronic handoff platform, the 'eSignout', which utilizes a standardized web-based information dashboard visible to all providers, automated paging features between ED and ward-based internal medicine physicians, and the option to electronically 'accept' signout, without verbal communication, while preserving the option for verbal discussion if either ED or medicine physicians deem appropriate. We hypothesized the eSignout would be perceived as safe and efficient by medicine residents, and favored over the former process of mandatory unstructured verbal signout for all ED to medicine transfers. In this study of recipient ward-based medicine residents' perceptions, we evaluated: (i) the change in reported near misses/adverse events and communication of key clinical information before and during the year following eSignout implementation and (ii) the overall perceptions regarding efficiency, safety and satisfaction with the new system. Additionally, to better understand the patient safety issues in ED to medicine ward transfers in the context of the new eSignout, we performed a qualitative analysis of near misses/adverse events reported by the residents during the post-intervention period.
Abstract and Introduction
Abstract
Objective. To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period.
Design. Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation.
Setting. University-based, tertiary-care hospital.
Participants. Internal medicine resident physicians admitting patients from the emergency department.
Intervention. An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers.
Main outcome measures. (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events.
Results. Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality.
Conclusions. The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.
Introduction
Successful and efficient communication of clinical information and transfer of responsibility between healthcare providers, also known as a 'handoff,' is vital for patient safety. Communication breakdowns can result in ineffective handoffs and are associated with adverse events, medical errors and patient safety risks. As a result, regulatory agencies, accrediting organizations and educators have increased focus on handoffs, calling for interventions aimed at improving the safety and effectiveness of handoffs to optimize patient care delivery.
Although handoffs between providers of the same service have been well studied, handoffs of patients transferred from one unit or specialty to another have not been well investigated. Such handoffs may be particularly vulnerable to breakdowns in the communication (or 'signout') process. In particular, patient transfers from the emergency department (ED) to medicine ward frequently involve clinical uncertainty and high acuity, which, along with cultural differences between services, can result in communication failures and insufficient information exchange at a critical stage in a patient's course. New handoff approaches using the current technology-enhanced health care environment to incorporate standardized electronic platforms for information exchange have potential to support safe and efficient between-unit transfers. To our knowledge, no work has investigated the perceived safety of an electronic handoff platform that does not require verbal communication between providers.
Our hospital implemented a new electronic handoff platform, the 'eSignout', which utilizes a standardized web-based information dashboard visible to all providers, automated paging features between ED and ward-based internal medicine physicians, and the option to electronically 'accept' signout, without verbal communication, while preserving the option for verbal discussion if either ED or medicine physicians deem appropriate. We hypothesized the eSignout would be perceived as safe and efficient by medicine residents, and favored over the former process of mandatory unstructured verbal signout for all ED to medicine transfers. In this study of recipient ward-based medicine residents' perceptions, we evaluated: (i) the change in reported near misses/adverse events and communication of key clinical information before and during the year following eSignout implementation and (ii) the overall perceptions regarding efficiency, safety and satisfaction with the new system. Additionally, to better understand the patient safety issues in ED to medicine ward transfers in the context of the new eSignout, we performed a qualitative analysis of near misses/adverse events reported by the residents during the post-intervention period.
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