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Patient Care Endangered By Less-Than-Smooth Handoffs

OMAHA, NE – How safe are handoffs from emergency departments to inpatient physicians for patients being admitted to the hospital?

The short answer might be that there is a lot of room for improvement, according to two recent studies.

One study, based on a survey of the clinicians involved, was published recently in the Journal of Hospital Medicine.

Another recent study, published in the Annals of Emergency Medicine, found that providers omitted communication of patient hypotension or hypoxia in nearly 1 in 7 ED handoffs, with study authors led by Yale University researchers noting, “These communication errors do not appear to be related to ED crowding or care interruptions.”

Noting that the handoffs involve “complex challenges,” the study team led by researchers from the University of Nebraska Medical Center College of Medicine assessed physicians' perceptions of the ED admission handoff process and identified potential barriers to safe patient care.

That study involved 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 five medical admitting services. Communication quality, clinical information, interpersonal perceptions, assignment of responsibilities, organizational factors, and patient safety all were assessed using a 5-point Likert scale and an open-ended description of handoff-related adverse events.

Admitting physicians, with a 63% response rate, were more likely to report that vital clinical information was communicated less frequently for all eight content areas than the 86% of EM physicians who responded. The emergency physicians, meanwhile, were highly likely (94%) to say they felt defensive at least “sometimes.”

More than a fourth, 29% of all respondents, reported handoff-related adverse events, usually related to ineffective communication. Sequential handoffs were common for both EM and admitting services, with 78% of physicians reporting they negatively affected patient care.

“Physicians reported that patient safety was often at risk during the ED admission handoff process,” study authors point out. “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.”

In the Yale-led study, researchers observed 1,163 patient handoffs during 130 ED shift rounds. Of 117 patients with episodes of hypotension and 156 patients with hypoxia, 42% and 74% were not communicated at rounds, respectively. Meanwhile, study authors point out, 166 handoffs included a vital sign communication error of omission.