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Study Finds Threats to Patient Safety During ‘Handoff’ from Emergency Department to Admission

Our malpractice attorneys in Seattle report on a study that found threats to patient safety during ‘handoff’ from the emergency department to patient admission.

Poor communication between emergency department (ED) and inpatient doctors during the “handoff” from the ED to hospital admission endangers patient safety, according to a new study from the University of Nebraska Medical Center published in the Journal of Hospital Medicine.

Researchers surveyed resident, fellow, and faculty physicians with direct involvement in admission handoffs from emergency medicine and five medical admitting services at a 627-bed tertiary care academic medical center. Participants were surveyed on communication quality, clinical information, interpersonal perceptions, assignment of responsibilities, organizational factors, and patient safety, according to the study abstract.

The researchers said the study’s findings demonstrate a need to collaborate to improve communication between ED and inpatient doctors during the handoff process, according to a press release about the study.

The study revealed several differences between the two groups of doctors. The admitting physicians were more likely than the ED doctors to report that important clinical information is frequently not communicated. The admitting doctors also reported inferior quality of communication and lower confidence in ensuring patient safety through the handoff system, the study found.

“We identified several perceived barriers to safe inter-unit handoff from the emergency department to the inpatient setting. Handoff-related adverse events, a pattern of conflicting physician perceptions, and frequent sequential handoffs were of particular concern,” the authors stated in the study announcement. “Our findings support the need for collaborative efforts to improve interdisciplinary communication.”

A Fierce Healthcare article on the study highlighted a disconnect between ED doctors and admitting doctors. Nearly all of the ED doctors surveyed — 94 percent — reported that they felt they had to defend their clinical judgment to admitting doctors at least some of the time. The idea that admitting physicians do not trust the medical decisions of ED doctors was further supported in that more than 25 percent of the admitting physicians surveyed reported they usually disagree with the medical decisions made in the ED.

Nearly a third of the doctors surveyed in the study reported adverse events related to patient handoffs. The doctors most frequently blamed these problems on ineffective communication. The study also reported that sequential handoffs — in which patients are moved from doctor to doctor, often in an attempt to diagnose the problem — are common in both the ED and the hospital admitting departments. In the survey, 78 percent of the doctors said sequential handoffs negatively affect patient care.

The study’s conclusion indicated a need for further research to better understand the complex patient handoff process and explore ways to improve it.

Fierce Healthcare reported that the results of the survey have prompted the University of Nebraska Medical Center to perform a pilot test of a standardized approach for patient handoffs from the ED to hospital admission. The medical center will survey the doctors again after implementing the pilot program.

The article also reported that the researchers believe the patient handoff procedure can be improved through training residents, including seeking more direct involvement from attending physicians and greater face-to-face communication.

The attorneys of Morrow Kidman Tinker Macey-Cushman, PLLC, are committed to patient safety and represent patients who have been harmed by preventable medical errors in Seattle and across Washington. Schedule a free consultation by calling us or contacting us online.

Sources:

  • Journal of Hospital Medicine – Interunit handoffs from emergency department to inpatient care: A cross-sectional survey of physicians at a university medical center
  • Medical Xpress – Docs report patient safety often at risk in ER to inpatient handoff
  • Fierce Healthcare – A potential weak link in patient safety: ER to inpatient handoffs