Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
| Autor: | Grace Chi, Nancy D. Spector, Robert Shields, Robert Blake, Kathleen Huth, Daniel C. West, Patrice Melvin, Jonathan Hatoun, Anne M. Stack, Amy J. Starmer |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Medical Errors business.industry Health Policy Medical record Communication Patient Handoff 030208 emergency & critical care medicine Emergency department Intervention studies 03 medical and health sciences Perceived quality 0302 clinical medicine Ambulatory care Emergency medicine medicine Outpatient clinic Illness severity Humans 030212 general & internal medicine Prospective Studies Communication quality business Child Emergency Service Hospital |
| Zdroj: | BMJ qualitysafety. 30(3) |
| ISSN: | 2044-5423 |
| Popis: | BackgroundMiscommunications 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.MethodsWe 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.ResultsAcross 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.ConclusionsImplementation 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. |
| Databáze: | OpenAIRE |
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