Journal article
Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
BMJ quality & safety, v 30(3), pp 208-215
01 Mar 2021
PMID: 32299957
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
Metrics
Details
- Title
- Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
- Creators
- Kathleen Huth - Boston Children's HospitalAnne M. Stack - Boston Children's HospitalJonathan Hatoun - Boston Children's HospitalGrace Chi - Boston Children's HospitalRobert Blake - Boston Children's HospitalRobert Shields - Boston Children's HospitalPatrice Melvin - Boston Children's HospitalDaniel C. West - Children's Hospital of PhiladelphiaNancy D. Spector - Drexel UniversityAmy J. Starmer - Boston Children's Hospital
- Publication Details
- BMJ quality & safety, v 30(3), pp 208-215
- Publisher
- Bmj Publishing Group
- Number of pages
- 8
- Grant note
- Program for Patient Safety & Quality, Boston Children's Hospital
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000624061800007
- Scopus ID
- 2-s2.0-85083884723
- Other Identifier
- 991019335228204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Health Care Sciences & Services
- Health Policy & Services