Patient Communication During Handovers Between Emergency Medicine and Internal Medicine Residents

Abstract

Background Communication failures are a key cause of medical errors and are particularly prevalent during handovers of patients between services. Objective To explore current perceptions of effectiveness in communicating critical patient information during admission handovers between emergency medicine (EM) residents and internal medicine (IM) residents. Methods Study design was a survey of IM and EM residents at a large urban hospital. Residents were surveyed about whether critical information was communicated during patient handovers. Measurements included comparisons between IM and EM residents about their perceptions of effective communication of key patient information and the quality of handovers. Results Ninety-three percent of EM residents (50 of 54) and 80% of IM residents (74 of 93) responded to the survey. The EM residents judged their handover performance to be better than how their IM colleagues assessed them on most questions. The IM residents reported that one-half of the time, EM residents provided organized and clear information, whereas EM residents self-reported that they did so most of the time (80%–90%). The IM residents reported that 25% of handovers were suboptimal and resulted in admission to an inappropriate level of care, and 10% led to harm or delay in care. The EM residents reported suboptimal communication was less common (5%). On the global assessment of whether the admission handover provided the information needed for good patient care, IM residents rated the quality of the handover data lower than did responding EM residents. Conclusions There are gaps in communicating critical patient information during admission handovers as perceived by EM and IM residents. This information can form the basis for efforts to improve these handovers.

Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit

“…There are many aspects to the handover process that involves not only verbal communication but also technical components such as moving equipment, monitors, lines, medications, and airway equipment. Poor communication and lack of team cohesiveness are common, but ameliorable, root causes for medical errors during handovers across different clinical settings .…”

“…The handover of pediatric cardiac surgical patients from the operating room to the intensive care unit is a critical and complex transition, ideally involving a multidisciplinary team of nurses, surgeons, anesthesiologists, respiratory technicians, and intensive care physicians . Our team successfully implemented a standardized multidisciplinary protocol for the handover of pediatric cardiac surgery patients to the intensive care unit that resulted in decreased technical errors and improved information transfer .…”

Focused Training for the Handover of Critical Patient Information During Simulated Pediatric Emergencies

“…1 Omission of critical patient information may occur at multiple points in the transitions of patient care during hospitalization. [2][3][4][5] Furthermore, transitions in care by resident physicians have been associated with hospital mortality. 6 The improvement of patient handovers has become a priority in efforts to enhance patient safety.…”

The Emergency Department (ED)-Inpatient Interface: improving the care of patients requiring emergency admission to hospital

“…Twelve papers primarily related to the processes of handover or handoff from the ED to inpatient environment. 15,16,20,21,[52][53][54][55][56][57][58][59] In keeping with the highest volume of ED to inpatient admissions, the majority of papers analysed the handover interactions between the ED and internal medicine services.…”

“…Tools such as standardised handover templates have been developed in an attempt to address some of these issues, however demonstration of benefit to important patient outcomes is lacking. 16,53 The majority of the handover literature explores handovers within the ED or within the inpatient unit, with handover studies crossing clinical boundaries such as EDii in the minority. 15,16 In a review by Hilligoss, only 9 out of 640 handover studies were related to ED-inpatient handovers 21 It is clear that ED to inpatient handovers are difficult due to their unscheduled nature interrupting scheduled inpatient activities such as clinics, surgery and ward rounds, clinical uncertainty, delays of uncertain duration, confusion over clinical ownership and a high risk of adverse clinical outcomes.…”