title: What constitutes a good hand offs in the emergency department: a patient's perspective.
abstract: OBJECTIVE
  The aim is to determine, from the patient's perspective, what constitutes a good hand-off procedure in the emergency department (ED). The secondary purpose is to evaluate what impact a formalized hand-off had on patient knowledge, throughput and customer service
  
  
  METHODS
  This study used a randomized controlled clinical trial involving two unique hand-off approaches and a convenience sample. The study alternated between the current hand-off process that documented the process but not specific elements (referred to as the informal process) to one using the IPASS the BATON process (considered the formal process). Consenting patients completed a 12-question validated questionnaire on how the process was perceived by patients and about their understanding why they waited in the ED. Statistical analysis using SPSS calculated descriptive frequencies and t-tests.
  
  
  RESULTS
  In total 107 patients were enrolled: 50 in the informal and 57 in the formal group. Most patients had positive answers to the customer survey. There were significant differences between formal and informal groups: recalling the oncoming and outgoing physician coming to the patient's bed (p = 0.000), with more formal group recalling that than informal group patients; the oncoming physician introducing him/herself (p = 0.01), with more from the formal group answering yes and the physician discussing tests and implications with formal group patients (p = 0.02).
  
  
  CONCLUSIONS
  This study was done at an urban inner city ED, a fact that may have skewed its results. A comparison of suburban and rural EDs would make the results stronger. It also reflected a very high level of customer satisfaction within the ED. This lack of variance may have meant that the correlation between customer service and handoffs was missed or underrepresented. There was no codified observation of either those using the IPASS the BATON script or those using informal procedures, so no comparison of level and types of information given between the two groups was done. There could have been a bias of those attending who had internalized the IPASS the BATON procedures and used them even when they were assigned to the informal group.
  
  
  CONCLUSIONS
  A hand off from one physician to the next in the emergency department is best done using a formalized process. IPASS the BATON is a useful tool for hand off in the ED in part because it involved the patient in the process. The formal hand off increased communication between patient and doctor as its use increased the patient's opportunity to ask and respond to questions.
  
  
  CONCLUSIONS
  The researchers evaluated an ED physician specific hand-off process and illustrate the value and impact of involving patients in the hand-off process.
authors.affiliation: Health Services/Public Administration Department, Roosevelt University, Chicago, Illinois, USA. ldowney@roosevelt.edu
authors.forename: La Vonne
authors.initials: LV
authors.lastname: Downey
authors.affiliation: Department of Emergency Medicine, Chicago, Mount Sinai Hospital, Illinois, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Zun
authors.affiliation: Department of Emergency Medicine, Chicago, Mount Sinai Hospital, Illinois, USA.
authors.forename: Trena
authors.initials: T
authors.lastname: Burke
mesh_terms: D000328:Adult; D003142:Communication; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards