In reply:

Abstract

We appreciate the comments from Dr. Freund in regard to our study. We read Dr. Freund’s and Dr. Kajdacsy-Ballar Amaral’s articles with great interest.1Freund Y. Goulet H. Bokobza J. et al.Factors associated with adverse events resulting from medical errors in the emergency department: two work better than one.J Emerg Med. 2013; 45: 157-162Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 2Kajdacsy-Balla Amaral A.C. Barros B.S. Barros C.C. et al.Nighttime cross-coverage is associated with decreased intensive care unit mortality: a single-center study.Am J Respir Crit Care Med. 2014; 189: 1395-1401Crossref PubMed Scopus (27) Google Scholar Our field has more work to do to identify the root cause of errors in a busy emergency department (ED) environment. In our experience, we can identify many instances in which errors or omissions occurred during handoffs,3Venkatesh A.K. Curley D. Chang Y. et al.Communication of vital signs at emergency department handoff: opportunities for improvement.Ann Emerg Med. 2015; 66: 125-130Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 4Maughan B.C. Lei L. Cydulka R.K. ED handoffs: observed practices and communication errors.Am J Emerg Med. 2011; 29: 502-511Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar and communication errors can negatively affect the care that we provide our patients.5Horwitz L.I. Meredith T. Schuur J.D. et al.Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care.Ann Emerg Med. 2009; 53: 701-710Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar Reporting vital signs, laboratory results, and medical decisionmaking accurately is important and inaccuracies can lead to delays and rework for not only that patient but also for other patients in our care. In addition, we have found that our model has benefits that go beyond reducing the sheer number of handoffs. It allows us to optimize our productivity at the beginning of our shift, when we are fresh, rather than spending an extended period getting to know a large number of patients before starting to treat new ones. Also, having fewer handoffs gives us more time with patients and trainees and improves continuity with families. Dr. Freund’s study on reducing adverse events in the ED by having systematic physician cross-checking is interesting. Although we do not currently have a formal system of reviewing cases, we agree that having the option for a second opinion may be positive for patient care. A benefit of our new “waterfall” scheduling model’s overlapping shift times is that we are often alongside another attending physician colleague in the ED, which provides increased opportunity for consulting each other and sharing knowledge. This is good in principle for patient safety and is satisfying from a professional standpoint. We agree that more studies are needed to evaluate the impact of handoffs on patient outcomes so we can provide the best care for our patients while creating a safe and rewarding working environment for providers. Waterfalls and Handoffs: A Novel Physician Staffing Model to Decrease Handoffs in a Pediatric Emergency DepartmentAnnals of Emergency MedicineVol. 74Issue 3PreviewWe read with interest the study by Yoshida et al,1 aiming at decreasing the number of handoffs in a pediatric emergency department (ED). Although we acknowledge that the authors achieved their objective in reducing the proportion of patients who were handed over, we question the hypothesis underlying their study. Full-Text PDF