Communicating in the “Gray Zone”: Perceptions about Emergency Physician–hospitalist Handoffs and Patient Safety

Apker, Julie; Mallak, Larry A.; Gibson, Susan I.

doi:10.1197/j.aem.2007.06.037

Cited by 102 publications

(71 citation statements)

References 26 publications

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“…Handoffs between physicians-in-training (3)(4)(5)(6), between nurses (7)(8)(9), and between ancillary staff such as respiratory therapists (7) are well-described in the literature. In contrast, transitions of care at the attending physician level have been less well studied (10)(11)(12)(13). With the exception of one single-center study (14), the handoff practices of intensivists have not been reported, and we know of no descriptions of how attending handoffs ought to be conducted.…”

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confidence: 98%

Are Attendings Different?. Intensivists Explain Their Handoff Ideals, Perceptions, and Practices

et al. 2014

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Purpose: What is known about physician handoffs is almost entirely limited to resident practice, but attending physicians ultimately determine care plans and goals of care. This study sought to understand what is unique about attending intensivist handoffs, to identify perceptions of the ideal content and format of intensive care unit (ICU) attending handoffs, and to understand how ideal and reported practices are aligned in the delivery of care.Methods: Intensivists in active practice in U.S. adult academic ICUs were purposively sampled and interviewed over 9 months in 2011 to 2012. Measurements and Main Results:Thirty attendings from 15 institutions in nine U.S. states were interviewed. Subjects' specialties included anesthesiology, emergency medicine, internal medicine, and surgery. The "perfect handoff" was described as succinct, included verbal plus written communication, and took place in person. Respondents believed that the attending handoff should be less detailed than resident handoffs. Most attendings participated in handoffs at the end of each ICU rotation (n = 26). Standardized handoff practice was rare (n = 1). Media used for handoffs included combinations of telephone conversations (n = 25), in-person communications (n = 11), e-mail (n = 9), or text message (n = 2). Handoff duration varied from 10 to 120 minutes for 5 to 42 patients. Five of 30 respondents had undergone formal training in how to conduct handoffs.Conclusions: A national sample of academic intensivists identified common ideal attributes of attending handoffs, yet their reported handoff practices varied widely. Ideal handoff practices may form the basis of future interventions to improve communication between intensivists.

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confidence: 98%

Are Attendings Different?. Intensivists Explain Their Handoff Ideals, Perceptions, and Practices

et al. 2014

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“…20,57 The IoM report states that ineffective handover has been identified as one of the leading causes of medical error in the ED. 1 Problems with shift handover in the emergency department Several studies have investigated shift handover in the ED.…”

Section: Handover and Communication In Emergency Carementioning

confidence: 99%

“…[20][21][22][23][24] This includes not only the 'telling of the story' by the person giving the handover, but also interpretation and confirmation of the story, and the development of a mental model by the recipient of the handover, which allows seamless transition of care. 22 In addition, handover can serve further functions other than simple information transfer.…”

Section: Handover As a Risk To Patient Safetymentioning

confidence: 99%

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

Sujan

Spurgeon

Inada-Kim

et al. 2014

Health Services and Delivery Research

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Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available. Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). PublisherEditorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: www.netscc.ac.uk/hsdr/ This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its proceeding programmes as project number 10/1007/26. The contractual start date was in April 2011. The final report began editorial review in January 2013 and was accepted for publication in May 2013. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, th...

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“…and recorded the responses, including (1) a brief description of the event, (2) factors the resident believed may have caused or contributed to the event, (3) whether the patient was passed off as already having a disposition and requiring no expected action on the part of the new physician or a patient requiring some follow-up action, and (4) if they believe there was any harm to the patient as a result of the error.…”

Section: Methodsmentioning

confidence: 99%

“…1 The transition of patient care, or ''hand off,'' between 2 physicians is an area of the medical system known to have risk for error. 2 It has not yet been definitively determined what educational steps are necessary for residents to become competent at minimizing errors during transitions of care. One necessary step of resident education is for the resident to first perceive and label when an error occurs.…”

Section: Introductionmentioning

confidence: 99%

Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department

Smith¹,

Burris²,

Mahmoud³

et al. 2011

Journal of Graduate Medical Education

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Background The Accreditation Council for Graduate Medical Education requirements for systems-based practice state residents are expected to participate in identifying system errors and implementing potential systems solutions. The objective of this study was to determine the numbers of perceived errors occurring from patient pass offs between resident physicians in our emergency department. Methods Using a prospective observational study, we queried emergency medicine residents about perceived errors in the transition of care using trained research assistants and a standardized protocol. Transition of care was defined as the transfer of responsibility to evaluate and treat and disposition of a patient in the emergency department from 1 resident physician to a second oncoming emergency department resident physician. Mean resident-perceived errors per shift and per patient transfer of care were calculated. Additionally, the mean number of perceived errors impacting patients was calculated. Results Emergency medicine residents on 107 shifts reported receiving 713 patients in pass off with a mean of 7 patients per physician per shift, with 40% of patients passed off needing some intervention (mean of 2.8 patients per provider per shift). Nineteen of the 107 shifts (17.8%) during which a resident took patients from a prior provider had a perceived error in at least 1 patient signed off. Of the 713 patients transitioned, the receiving physician perceived an error related to the transition of care for 23. Two of the 23 errors were determined by reviewing emergency medicine attendings to not be errors, and for 9 the receiving physician perceived an impact on the patient. All were delays in care or disposition. Conclusion Our data suggest emergency medicine residents were able to perceive errors related to transitions of care, describe the types of pass-off errors, and, to a lesser degree, describe the impact these errors have on patients.

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Communicating in the “Gray Zone”: Perceptions about Emergency Physician–hospitalist Handoffs and Patient Safety

Cited by 102 publications

References 26 publications

Are Attendings Different?. Intensivists Explain Their Handoff Ideals, Perceptions, and Practices

Are Attendings Different?. Intensivists Explain Their Handoff Ideals, Perceptions, and Practices

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department

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