title: Resident to resident handoffs in the emergency department: an observational study.
abstract: BACKGROUND
  Despite patient handoffs being well recognized as a potentially dangerous time in the care of patients in the emergency department (ED), there is no established standard and little supporting research on how to optimize the process. Minimizing handoff risks is particularly important at teaching hospitals, where residents often provide the majority of patient handoffs.
  
  
  OBJECTIVE
  Our aim was to identify hazards to patient safety and barriers to efficiency related to resident handoffs in the ED.
  
  
  METHODS
  An observational study was completed using the Systems Engineering Initiative for Patient Safety model to assess the safety and efficiency of resident handoffs. Thirty resident handoffs were observed with residents in emergency medicine over 16 weeks.
  
  
  RESULTS
  Residents were interrupted, on average, every 8.5 min. The most common deficit in relaying the plan of care strategy was failing to relay medications administered (32%). In addition, there were ambiguities related to medication administration, such as when the medication was next due or why a medication was chosen, in 56% of handoffs observed. Ninety percent of residents observed took handwritten notes. A small percentage (11%) also completed free texted computer progress notes. Ten percent of residents took no notes.
  
  
  CONCLUSIONS
  The existing system allows for a clear summary of the patient's visit. Two major deficits-frequent interruptions and inconsistent communication regarding medications administered-were noted. There is inconsistency in how information is recorded at the time of handoff. Future studies should focus on handoff improvement and error reduction.
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Peterson
authors.affiliation: Armstrong Institute for Patient Safety and Quality, School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ayse P
authors.initials: AP
authors.lastname: Gurses
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Linda
authors.initials: L
authors.lastname: Regan
mesh_terms: D003142:Communication; D003201:Computers; D004358:Drug Therapy; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007396:Internship and Residency; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D061214:Patient Safety; D018570:Risk Assessment; D013997:Time Factors
keywords: hand offs; observational study; patient safety; resident; transitions of care