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Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
  1. Kathleen Huth1,
  2. Anne M Stack2,
  3. Jonathan Hatoun1,
  4. Grace Chi1,
  5. Robert Blake3,
  6. Robert Shields3,
  7. Patrice Melvin4,
  8. Daniel C West5,6,
  9. Nancy D Spector7,
  10. Amy J Starmer1
  1. 1 Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2 Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  3. 3 Emergency Communication Center, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4 Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, Massachusetts, USA
  5. 5 Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  6. 6 Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  7. 7 Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Kathleen Huth, Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA; kathleen.huth{at}


Background Miscommunications during care transfers are a leading cause of medical errors. Recent consensus-based recommendations to standardise information transfer from outpatient clinics to the emergency department (ED) have not been formally evaluated. We sought to determine whether a receiver-driven structured handoff intervention is associated with 1) increased inclusion of standardised elements; 2) reduced miscommunications and 3) increased perceived quality, safety and efficiency.

Methods We conducted a prospective intervention study in a paediatric ED and affiliated clinics in 2016–2018. We developed a bundled handoff intervention included a standard template, receiver training, awareness campaign and iterative feedback. We assessed a random sample of audio-recorded handoffs and associated medical records to measure rates of inclusion of standardised elements and rate of miscommunications. We surveyed key stakeholders pre-intervention and post-intervention to assess perceptions of quality, safety and efficiency of the handoff process.

Results Across 162 handoffs, implementation of a receiver-driven intervention was associated with significantly increased inclusion of important elements, including illness severity (46% vs 77%), tasks completed (64% vs 83%), expectations (61% vs 76%), pending tests (0% vs 64%), contingency plans (0% vs 54%), detailed callback request (7% vs 81%) and synthesis (2% vs 73%). Miscommunications decreased from 48% to 26%, a relative reduction of 23% (95% CI −39% to −7%). Perceptions of quality (35% vs 59%), safety (43% vs 73%) and efficiency (17% vs 72%) improved significantly post-intervention.

Conclusions Implementation of a receiver-driven intervention to standardise clinic-to-ED handoffs was associated with improved communication quality. These findings suggest that expanded implementation of similar programmes may significantly improve the care of patients transferred to the paediatric ED.

  • hand-off
  • ambulatory care
  • emergency department
  • transitions in care

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  • Funding This study was funded by Program for Patient Safety & Quality, Boston Children's Hospital.

  • Competing interests NS, AJS and DCW have consulted with and hold equity in the I-PASS Patient Safety Institute, which seeks to train institutions in best handoff practices and aid in their implementation. NS, AJS and DCW also reported receiving honoraria and travel reimbursement from multiple academic and professional organisations for delivering lectures on handoffs and patient safety.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institution’s Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.