PT - JOURNAL ARTICLE AU - Kathleen Huth AU - Anne M Stack AU - Jonathan Hatoun AU - Grace Chi AU - Robert Blake AU - Robert Shields AU - Patrice Melvin AU - Daniel C West AU - Nancy D Spector AU - Amy J Starmer TI - Implementing receiver-driven handoffs to the emergency department to reduce miscommunication AID - 10.1136/bmjqs-2019-010540 DP - 2021 Mar 01 TA - BMJ Quality & Safety PG - 208--215 VI - 30 IP - 3 4099 - http://qualitysafety.bmj.com/content/30/3/208.short 4100 - http://qualitysafety.bmj.com/content/30/3/208.full SO - BMJ Qual Saf2021 Mar 01; 30 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.