title: Interunit handoffs from emergency department to inpatient care: A cross-sectional survey of physicians at a university medical center.
abstract: BACKGROUND
  Emergency department (ED) to inpatient physician handoffs are subject to complex challenges. We assessed physicians' perceptions of the ED admission handoff process and identified potential barriers to safe patient care.
  
  
  METHODS
  We conducted a cross-sectional survey at a 627-bed tertiary care academic medical center. Eligible participants included all resident, fellow, and faculty physicians directly involved in admission handoffs from emergency medicine (EM) and 5 medical admitting services. The survey addressed communication quality, clinical information, interpersonal perceptions, assignment of responsibilities, organizational factors, and patient safety. Participants reported their responses via a 5-point Likert scale and an open-ended description of handoff-related adverse events.
  
  
  RESULTS
  Response rates were 63% for admitting (94/150) and 86% for EM physicians (32/37). Compared to EM respondents, admitting physicians reported that vital clinical information was communicated less frequently for all 8 content areas (P < 0.001). Ninety-four percent of EM physicians felt defensive at least "sometimes." Twenty-nine percent of all respondents reported handoff-related adverse events, most frequently related to ineffective communication. Sequential handoffs were common for both EM and admitting services, with 78% of physicians reporting they negatively impacted patient care.
  
  
  CONCLUSIONS
  Physicians reported that patient safety was often at risk during the ED admission handoff process. Admitting and EM physicians had divergent perceptions regarding handoff communication, and sequential handoffs were common. Further research is needed to better understand this complex process and to investigate strategies for improvement.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smith
authors.affiliation: Department of Health Promotion, Social, and Behavioral Health, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska.
authors.forename: Denise H
authors.initials: DH
authors.lastname: Britigan
authors.affiliation: Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lyden
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Nathan
authors.initials: N
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
authors.forename: Ted J
authors.initials: TJ
authors.lastname: Welniak
authors.affiliation: University of Nebraska Medical Center College of Medicine and Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Wadman
mesh_terms: D000046:Academic Medical Centers; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D062209:Patient Handoff / Q000592:standards*; D061214:Patient Safety; D010820:Physicians / Q000458:organization & administration*; D000078329:Workforce