title: A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification.
abstract: OBJECTIVE
  Emergency department (ED) shift handoffs are sources of potential medical error, delays in care, and medicolegal liabilities. Few handoff studies exist in the ED literature. We aimed to describe the implementation of a standardized checklist for improving situational awareness during physician handoffs in a pediatric ED.
  
  
  METHODS
  This is a descriptive observational study in a large academic pediatric ED. Checklists were evaluated for rates of use, completion, and identification of potential safety events. We defined a complete checklist as 80% or more of items checked.  A user perception survey was used. After 1 year, all checklist users (residents, fellows, faculty, and charge nurses with ED experience before and after checklist implementation) were anonymously surveyed to assess the checklist's usability, perceived contributions to Institute of Medicine quality domains, and situational awareness. The electronically administered survey used Likert frequency scales.
  
  
  RESULTS
  Of 732 handoffs, 98% used the checklist, and 89% were complete. A mean of 1.7 potential safety events were identified per handoff. The most frequent potential safety events were identification of intensive care unit-level patients in the ED (48%), equipment problems (46%), staffing issues (21%), and intensive care unit-level patients in transport (16%). Eighty-one subjects (88%) responded to the survey. The users agreed that the checklist promoted better communication, safety, efficiency, effective care, and situational awareness.
  
  
  CONCLUSIONS
  The Physician Active Shift Signout in the Emergency Department briefing checklist was used often and at a high completion rate, frequently identifying potential safety events. The users found that it improved the quality of care and team communication. Future studies on outcomes and processes are needed.
authors.affiliation: From the *Division of Emergency Medicine, Children's National Medical Center, George Washington University, Washington, DC; †Section of Emergency Medicine-Department of Pediatrics, Center for Clinical Effectiveness, Texas Children's Hospital; and ‡Section of Emergency Medicine-Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Mullan
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.forename: Deborah
authors.initials: D
authors.lastname: Hsu
authors.forename: Sartaj
authors.initials: S
authors.lastname: Alam
authors.forename: Binita
authors.initials: B
authors.lastname: Patel
mesh_terms: D001364:Awareness; D057189:Checklist; D002648:Child; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000639:trends; D014193:Trauma Centers / Q000592:standards*; D014481:United States