Transfer of care between healthcare providers is a vulnerable time for patient safety, and ED admission handoffs are subject to unique structural and contextual challenges. The ED admission process involves changes in provider, department, and physical location. It also occurs early in a patient’s evaluation when the clinical trajectory is uncertain. To better understand the barriers to effective handoff communication, we surveyed admitting and emergency physicians about their experiences and beliefs.
A cross‐sectional survey was conducted at a 627‐bed tertiary‐care teaching hospital. Questions were created to examine five domains: clinical content, interpersonal perceptions, expectations, organizational factors, and patient safety. Surveys were distributed to residents, fellows, and faculty physicians from emergency medicine (EM) and six medical admitting services, which account for two‐thirds of ED admissions. Data was analyzed using SPSS software. Fisher’s Exact Test was used to compare dichotomized responses between EM and admitting physicians.
Based on preliminary survey results, a supplemental study was designed to determine the frequency in which 8 pieces of vital handoff information were communicated. Prospective data was collected by a triage hospitalist immediately following oral handoff and was documented as communicated without prompting, communicated with prompting, or not communicated.
A total of 117 admitting (67%) and 32 EM (86%) physicians completed the survey. There was significant disagreement between EM and admitting physicians across multiple domains. Admitting physicians reported communication of clinical information occurred less frequently than EM physicians (p‐value <0.05 for all eight content areas). Nearly all EM physicians felt they had to defend their decisions and face‐to‐face communication was rare. Most respondents were unable to correctly identify who was responsible for patients “boarding” in the ED. Clinical duties frequently distracted physicians during handoff, but environmental factors more commonly distracted EM physicians (p=0.007). Sequential handoffs occurred regularly and were felt to have negative impact on patient care. Adverse outcomes related to handoff communication were reported by 30% of respondents.
Prospective data from 89 admission handoffs were collected. Most clinical information was communicated regularly, often with prompting from the admitting physician. The content areas least frequently communicated were treatments initiated in the ED (71.9%), trend in the patient’s clinical condition (57.3%), and pending studies (34.8%).
These results highlight several barriers to the safe transfer of patients from the ED. Admitting and EM physicians had vastly different perceptions about communication of clinical information, despite the fact that most information was communicated regularly. Inter‐disciplinary biases and mistrust likely play a role in this discrepancy. Handoff information was also compromised by sequential handoffs, lack of face‐to‐face communication, and distractions. Lack of clearly delineated responsibilities may also contribute to adverse patient outcomes. These results demonstrate the complex interplay of contributing factors that impact admission handoff. Improvement efforts should be multifaceted and include inter‐disciplinary team‐building, rather than strictly focusing on transfer of information.
To cite this abstract:Smith C, Britigan D, Anderson N, Lyden E, Wadman M. Ed to Hospital Handoffs: Physicians’ Experiences, Perceptions, and Attitudes. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 167. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/ed-to-hospital-handoffs-physicians-experiences-perceptions-and-attitudes/. Accessed May 24, 2019.