Abstract
IntroductionSuboptimal communication during emergency department (ED) care transitions has been shown to contribute to medical errors, sometimes resulting in patient injury and litigation. The study objective was to determine whether a standardized checkout process would decrease the number of relevant missed clinical items (MCI).MethodsIn this prospective pre- and post-intervention study conducted in an urban academic ED, we collected data on omitted or inaccurately conveyed medical information before and after the initiation of a standardized checkout process. The intervention included group checkout in an optimal location, review of electronic medical records, case discussion and assigned roles. MCI were considered relevant if they resulted in a delay or alteration in disposition or treatment plan. The primary outcome was the change in the number of MCI. Secondary outcomes were duration of checkout and physician satisfaction with the intervention.ResultsPre-intervention, there were 94 relevant MCI during 164 care transitions. Post-intervention, there were 36 MCI in 157 transitions. The mean MCI per transition decreased by 58% from 0.57 (95% confidence interval [CI] [0.41, 0.73]) to 0.23 (95% CI [0.11–0.35]). Instituting the intervention did not lengthen checkout duration, which was 15 minutes (95% CI [13.81–16.19]) pre-intervention and 14 minutes (95% CI [12.99–15.01]) post-intervention. The majority of participants (73.4%) felt that the process decreased MCI, and 89.5% reported that the new process had a positive or neutral effect on their satisfaction with care transitions.ConclusionThe adoption of a standardized care transition process markedly decreased clinically relevant communication errors without lengthening checkout duration.
Highlights
Suboptimal communication during emergency department (ED) care transitions has been shown to contribute to medical errors, sometimes resulting in patient injury and litigation
The mean missed clinical items (MCI) per transition decreased by 58% from 0.57 (95% confidence interval [confidence intervals (CI)] [0.41, 0.73]) to 0.23
The majority of participants (73.4%) felt that the process decreased MCI, and 89.5% reported that the new process had a positive or neutral effect on their satisfaction with care transitions
Summary
Improving Information Transferred During ED Care Transitions issues.[2] In addition, one study found that 24% of liability claims against ED providers included care transitions as a contributing factor.[3] Previous studies have described a subjective decrease in the handoff error rate and an increase in physician satisfaction with the use of standardized transfer of care processes. Despite these results, there has been little consensus regarding the most valuable components of standardization. Multiple sources including the Joint Commission, American College of Emergency Physicians (ACEP), and a survey of emergency medicine (EM) residency directors have noted the need for improved standardization of patient checkout for a more complete transfer of information
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