title: Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm.
abstract: BACKGROUND
  We aimed to assess the current scope of handoff education and practice among resident physicians in academic centers and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED) to an inpatient setting.
  
  
  METHODS
  This was a cross-sectional survey targeted at the program directors, associate or assistant program directors, and faculty members of emergency medicine (EM) residency programs in the United States (U.S.). The web-based survey was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff.
  
  
  RESULTS
  121 of 172 programs responded to the survey for an overall response rate of 70.3%. Our survey showed that most EM programs in the U.S. have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system, over 70% of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess the handoff proficiency of trainees. Handoffs most commonly take place over the phone, though respondents disagree about the ideal place for a handoff to occur, with nearly equivalent responses between programs favoring the bedside over the phone or face-to-face on a computer. Approximately two-thirds of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and on the review of the literature, we developed a five-step algorithm for the transition of care from the ED to the inpatient setting.
  
  
  CONCLUSIONS
  Our results identified the current trends of education and practice in transitions of care, from the ED to the inpatient setting in U.S. academic medical centers. An algorithm, which guides this process, is proposed to address the current gap in the standardized approach to ED to inpatient handoffs that were identified in the survey's assessment of needs.
authors.affiliation: The University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa.
authors.forename: Sangil
authors.initials: S
authors.lastname: Lee
authors.affiliation: Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California.
authors.forename: H Gene
authors.initials: HG
authors.lastname: Hern
authors.affiliation: Duke University, Department of Emergency Medicine and Internal Medicine, Durham, North Carolina.
authors.forename: Chad
authors.initials: C
authors.lastname: Kessler
authors.affiliation: Pennsylvania State University, Department of Emergency Medicine, State College, Pennsylvania.
authors.forename: Susan
authors.initials: S
authors.lastname: Promes
authors.affiliation: University of Illinois at Peoria, Department of Emergency Medicine, Peoria, Illinois.
authors.forename: Sarah
authors.initials: S
authors.lastname: Krzyzaniak
authors.affiliation: University of Washington, Department of Emergency Medicine, Seattle, Washington.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gallahue
authors.affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Ted
authors.initials: T
authors.lastname: Stettner
authors.affiliation: University of Colorado, Department of Emergency Medicine, Aurora, Colorado.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Druck
mesh_terms: D000046:Academic Medical Centers; D000465:Algorithms; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007396:Internship and Residency / Q000592:standards*; D020380:Needs Assessment; D062209:Patient Handoff / Q000592:standards*; D010360:Patient Transfer / Q000639:trends*; D011795:Surveys and Questionnaires; D014481:United States