title: Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool.
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.
  
  
  METHODS
  Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation.
  
  
  METHODS
  University-based, tertiary-care hospital.
  
  
  METHODS
  Internal medicine resident physicians admitting patients from the emergency department.
  
  
  METHODS
  An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers.
  
  
  METHODS
  (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.
authors.affiliation: Assistant Professor of Medicine and Public Health Sciences, Assistant Dean for Health Systems Education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania jgonzalo@hmc.psu.edu jedgonzalo@hotmail.com.
authors.forename: Jed D
authors.initials: JD
authors.lastname: Gonzalo
authors.affiliation: Director of Inpatient Quality, Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, and Assistant Professor, Harvard Medical School, Boston, Massachusetts.
authors.forename: Julius J
authors.initials: JJ
authors.lastname: Yang
authors.affiliation: Assistant Professor of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Stuckey
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Instructor in Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Fischer
authors.affiliation: Vice Chair for Emergency Department Operations, Beth Israel Deaconess Medical Center, and Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
authors.affiliation: Instructor in Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Shoshana J
authors.initials: SJ
authors.lastname: Herzig
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006751:Hospital Information Systems / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D010360:Patient Transfer / Q000458:organization & administration*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration
keywords: adverse events; emergency care; general medicine; health care system; health system reform; hospital care; patient safety; professions; quality improvement; quality management; setting of care