Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.
Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.
Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, MC 7736, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. kamna.balhara@gmail.com.
Kamna S
KS
Balhara
Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Susan M
SM
Peterson
Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
Mohamed Moheb
MM
Elabd
Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Linda
L
Regan
Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
Xavier
X
Anton
Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
Basil Ali
BA
Al-Natour
Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Yu-Hsiang
YH
Hsieh
Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
James
J
Scheulen
Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Sarah A
SA
Stewart de Ramirez
D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D038622:Internationality; D062209:Patient Handoff / Q000592:standards* / Q000639:trends; D061214:Patient Safety / Q000592:standards; D011446:Prospective Studies; D012015:Reference Standards; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D000078329:Workforce
Clinical handoff; Emergency service, hospital; Inter-unit communication; Patient admission