Evaluation of Process Improvement Interventions on Handoff Times between the Emergency Department and Observation Unit

Abstract

Mitigating hospital crowding requires judicious use of inpatient resources, making Emergency Department Observation Units (EDOUs) an increasingly vital destination for patients that are not suitable for discharge. Maximizing the utility of the EDOU hinges on efficient patient transfers and safe provider communication, which may be accomplished with asynchronous handoff and an emphasis on pull-through operations. The purpose of this study was to assess the impact of an electronic, asynchronous handoff replacing verbal handoff on transfer times from the Emergency Department (ED) to the EDOU. A retrospective observational study was performed with patients transferred to the EDOU throughout several process improvement measures focused on asynchronous handoff. Multivariable linear regression analysis was used to determine the effect that these process improvements had on the time from EDOU bed assignment to patient transfer. There were 14,996 EDOU stays during the 20-month period included in the analysis. Time from EDOU bed assignment to patient transfer decreased significantly with all three interventions studied. An auto-page to the clinicians notifying them of a ready bed reduced the mean time to transfer by 10.1min (p<0.0001), asynchronous nursing handoff reduced it by 3.57min (p=0.0299), and asynchronous clinician handoff reduced it by 14.67min (p<0.0001). Introducing automatic pages regarding bed status and converting the handoff process from a verbal model to an asynchronous, electronic handoff were effective ways to reduce the time from bed assignment to transfer out of the ED for patients being sent to the EDOU.