RT Journal Article
SR Electronic
T1 Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP bmjqs-2019-010540
DO 10.1136/bmjqs-2019-010540
A1 Kathleen Huth
A1 Anne M Stack
A1 Jonathan Hatoun
A1 Grace Chi
A1 Robert Blake
A1 Robert Shields
A1 Patrice Melvin
A1 Daniel C West
A1 Nancy D Spector
A1 Amy J Starmer
YR 2020
UL http://qualitysafety.bmj.com/content/early/2020/04/15/bmjqs-2019-010540.abstract
AB 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.