Patient Handoffs Research Articles

OrthoPass: Long-term Outcomes following Implementation of an Orthopaedic Patient Handoff Template.

Standardized handoff tools improve communication and patient care; however, their widespread use in surgical fields is lacking. OrthoPass, an orthopaedic adaptation of I-PASS, was developed in 2019 to address handoff concerns and demonstrated sustained improvements across multiple handoff domains over an 18-month period. We sought to characterize the longitudinal effect and sustainability of OrthoPass within a single large residency program 3.5 years after its implementation. This mixed methods study involved electronic handoff review for quality domains in addition to survey distribution and evaluation. We conducted comparative analyses of handoff adherence and survey questions as well as a thematic analysis of provider-free responses. We evaluated 146 electronic handoffs orthopaedic residents, fellows, and advanced practice providers 3.5 years after OrthoPass implementation. Compared with 18-month levels, adherence was sustained across five of nine handoff domains and was markedly improved in two domains. Furthermore, provider valuations of OrthoPass improved regarding promoting communication and patient safety (83% versus 70%) and avoiding patient errors and near misses (72% versus 60%). These improvements were further substantiated by positive trends in Agency for Healthcare Research and Quality Surveys on Patient Safety Culture hospital survey data. Thematic analysis of free responses shared by 37 providers (42%) generated favorable, unfavorable, and balanced themes further contextualized by subthemes. At 3.5 years after its introduction, OrthoPass continues to improve patient handoff quality and to support provider notions of patient safety. Although providers acknowledged the benefits of this electronic handoff tool, they also shared unique insights into several drawbacks. This feedback will inform ongoing efforts to improve OrthoPass.

Use of Stroke Alert Sticker in the Field Decreases Time to Acute Interventions for Ischemic Stroke Patients.

BACKGROUND: Stroke is a medical emergency requiring timely intervention to optimize patient outcomes. The only treatments currently Food and Drug Administration approved for acute stroke are intravenous (IV) thrombolytics, which require obtaining specific medical history to be administered safely. This medical history may be overlooked in the prehospital setting or lost during patient handoff between emergency medical services (EMS) personnel and hospital staff, delaying treatment. We evaluated whether utilization of a "stroke alert sticker" by EMS to capture key information in the field would decrease door-to-needle (DTN) time. METHODS: Bright-orange "stroke alert stickers" were disseminated to our local EMS agency to be placed on all suspected stroke patients in the field prompting documentation of key elements needed for timely treatment decisions. The "stroke alert sticker" included time last known well, contact information, presenting symptoms, and relevant medications. We evaluated the impact of the "stroke alert sticker" on acute stroke metrics, including DTN time. RESULTS: The project included 220 consecutive stroke alert patients brought to our comprehensive stroke center by a single EMS agency from May 2021 through February 2022. Twenty-one patients were treated with an IV thrombolytic. Overall "stroke alert sticker" use compliance was 40%; for the subgroup of patients who were given an IV thrombolytic, the "stroke alert sticker" was used 60% of the time. In patients who received an IV thrombolytic, prehospital EMS notification was 100% with "stroke alert sticker" use, compared with 75% without (P = .13). In addition, with "stroke alert sticker" utilization, DTN time was reduced by 20 minutes (31 [11] minutes with sticker vs 51 [21] minutes without, P = .04). CONCLUSION: Utilization of the "stroke alert sticker" significantly improved DTN times compared with patients without the sticker. This evidence supports continued use of the "stroke alert sticker" to improve DTN times and patient outcomes.

Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations.

The diagnostic process is a dynamic, team-based activity that is an important aspect of ward rounds in teaching hospitals. However, few studies have examined how academicward teams operate in areas such as diagnosis in the handoff of overnight admissionsduring ward rounds. This study draws key lessons from team interactions in the handoff process during ward rounds. To describe how ward teams operate in the handoff of patients admitted overnight during ward rounds, and to characterize the role of the bedside patient evaluation in this context. A qualitative ethnographic approach using field observations and documentary analysis. Attendingphysicians, medical residents, and medical students on general medicine services in a single teaching hospital. Thirty-five hours of observations were undertaken over a 4-month period. We purposively approached a diverse group of attendings who cover a range of clinical teaching experience, and obtained informed consent from all ward team members and observed patients. Thirty patient handoffs were observed across 5 ward teams with 45 teammembers. We conducted thematic analysis of researcher field notes and electronic health record documents using social cognitive theories to characterize the dynamic interactions occurring in the real clinical environment. Teams spent less time during ward rounds on verifyinghistory and physical examination findings, performingbedside evaluations, and discussing differentialdiagnoses than other aspects (e.g., reviewing patientdata in conference rooms) in the team handoff process of overnight admissions. Several team-based approaches to diagnosis and bedside patient evaluationswere observed, including debriefing for learning and decision-making. This study highlights potential strengths and missed opportunities for teaching, learning, and engaging directly with patients in the ward team handoff of patients admitted overnight. These findings may inform curriculum development, faculty training, and patient safety research.

“Two Years Later I’m Still Just as Angry”: A Focus Group Study of Emergency and Internal Medicine Physicians on Disrespectful Communication

Phenomenon: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. Approach: In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center. Findings: We organized focus group results into four overarching categories related to disrespectful communication: characteristics and context (including specific phrasing that members from each department interpreted as disrespectful, effects of listener engagement/disengagement, and the tendency for communication that is not in-person to result in misunderstanding and conflict); differences across training levels (with disrespectful communication more likely when participants were at different training levels); the individual correspondent’s tendency toward perceived rudeness; and negative/long-term impacts of disrespectful communication on the individual and environment (including avoidance and effects on patient care). Insights: In the context of predominantly positive descriptions of interdepartmental communication, participants described episodes of perceived disrespectful behavior that often had long-lasting, negative impacts on the quality of the learning environment and clinical work. We created a conceptual model illustrating the process and outcomes of these interactions. We make several recommendations to reduce disrespectful communication that can be applied throughout the hospital to potentially improve patient care, interdepartmental collaboration, and trainee and faculty quality of life.

Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams.

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science.

A Framework Study on a Real-Time Operated System for Emergency Medical Services (EMS) using NODEMCU Processor

Emergency Medical Services (EMS) has always been a great help in treating patients before they arrive at the hospital. On the route to the hospital, where they will receive proper and additional treatment, pre-hospital care is an emergency aid to help stabilise the patient's condition. However, there is a lack of effective maintenance in the data interchange between the emergency department doctors and the paramedics in the ambulance. To give the patient the highest level of treatment, the patient's handoffs from paramedics or pre-hospital to in-hospital staff are not of sufficient quality. Hence came the idea of incorporating the Internet of Things into the emergency healthcare system. This paper discusses a proposed idea to design a reliable healthcare monitoring system that enables data exchange between doctors and paramedics efficiently. This system utilises the IoT platform, Blynk App, to display the data in both places (ambulance and emergency department) by using NodeMCU as the core processor and wearable sensors to measure the main parameters and vital sign data (as is current practise in ambulances). This system may also confirm that data from the sensors is transmitted in real-time to the host computer. The findings indicate that the vital sign readings are roughly accurate when compared to actual devices or marketable measurement tools. At the same time, the system will help the paramedics and doctors communicate efficiently in two ways and enable them to exchange patient details in real-time, so appropriate action can be discussed and the patient can be treated swiftly. The provided information allows hospital professionals in the emergency department to suggest what tools or medications should be ready to treat the patient further.

Interprofessional Education: Collaborative Team Work Among Undergraduate Medical Students.

Madam, The last decade has been a global shift towards collaborative learning and practice. A Joint Commission Report noticed that 80% of all medical errors were due to miscommunications during patient handoffs, with 44% occurring in inpatient settings1. Learning Together to Work Together for Health is the essential guide for the working of Interprofessional Education (IPE), the idea presented by WHO and is defined as an experience that “occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve outcomes”2. The core competencies for IPE include collaborative teamwork, communication skills, ethical practice, roles and responsibilities, and conflict resolution2. IPE expects to improve the knowledge, skills, and attitudes towards collaboration to enhance their future clinical practice. Pakistan is a developing country that is strengthening IPE. The Karachi Medical and Dental College launched a training program on research methodology focusing on the principles of IPE to improve primary care delivery2. The Dental Hygiene Program at Aga Khan University is also an example of IPE improving patient healthcare3. These deficiencies can be overcome by vertically and horizontally integrating IPE in the curriculum. The absence of a formal team-based care programme deprives most students from learning about professional roles. This warrants a need to focus on learning approaches that can be used in undergraduate curricula and thereby create and foster a collaborative learning environment. Case-based learning and team-based learning are valuable approaches resulting in experiential learning and reflection. Simulations allow students to practice and improve their communication and collaboration among medical students. E-learning is worthwhile for enlightening their understanding and cognizance of further profession’s duties and authorities, which is unique to the leading competencies of IPE4. The logistics of setting up IPE activities may be more challenging. The leadership confrontation such as lack of management between the faculties and lack of support by organization, curriculum challenges like IPE courses designing, teaching challenges, such as shortage of faculty members training, skills and competence in interprofessional and resistance to transformation i.e. dearth of resources are the main challenges for the institutions5. The institutions should engage in policies in the best strategies to implement interprofessional education. Hierarchical heads and policymakers need to put forth an effort to advance IPE so that different professions can benefit from each other more easily.

Reducing medical errors for older veterans through communication, mediation and quality assurance

This study aims to evaluate the effectiveness of integrated strategies—communication protocols, mediation techniques, and quality assurance (QA) measures—in reducing medical errors among older veterans within the Veterans Health Administration (VHA). The research seeks to identify key factors contributing to errors and assess the impact of targeted interventions on enhancing patient safety. A mixed-methods research design was employed, combining qualitative interviews with healthcare providers, veterans, and caregivers, alongside quantitative analysis of medical records, incident reports, and patient safety surveys. The study utilized stratified sampling to ensure diversity across different VHA facilities and applied statistical techniques, including chi-square tests, logistic regression, and bootstrapping, to evaluate the effectiveness of interventions. The findings indicate a significant reduction in medical errors through the implementation of standardized communication protocols, particularly during patient handoffs. Mediation effectively resolved conflicts arising from errors, fostering a culture of transparency and continuous improvement. Facilities with robust QA programs demonstrated higher success rates in identifying and mitigating potential risks. The integration of these strategies led to a 45% reduction in overall error rates, with communication errors showing the most substantial decline. The study highlights the critical role of communication, mediation, and QA in enhancing patient safety within veterans' healthcare. While the results demonstrate the effectiveness of these strategies, challenges such as resource variability and the need for ongoing training persist. The research underscores the importance of adopting a multi-faceted approach to error reduction and suggests further exploration of advanced technologies and longitudinal studies to assess the sustainability of these interventions.

Plan For Tomorrow: The Experience of Adolescent and Young Adult Childhood Cancer Survivors as they Transition to Adult Care

Access to and understanding one's medical history is crucial to maintaining long-term care. As adolescents and young adults childhood cancer survivors age, they must transition and transfer their health care from their pediatric to an adult care institution. In this study, we provide empirical evidence reporting on the after-cancer treatment experiences of childhood cancer survivors through their transition. We report findings from 24 semi-structured interviews with adolescent and young adult cancer survivors participating in a childhood cancer survivorship program that prepares them for adult care. Our findings reveal three parts of their after-cancer treatment experience: the assumption of responsibility for their complex care needs and medical information and the overall transfer and maintenance of the continuity of their care to an adult clinician. Our findings suggest that survivors may play an essential yet unrecognized role in the patient hand-off. Thus, we introduce patient-mediate handoffs and suggest design opportunities.

Evaluating Physician Stress During Patient Handoffs: Analysis of Physician Heart Rate Variability, Patient Handoff Characteristics, and ED Metrics

Patient handoffs represent a critical point in patient care, specifically in hospital Emergency Departments (EDs) where handoffs occur at every shift change. Previous studies have examined ED patient handoffs primarily by evaluating handoff communication methods and scheduling models that improve and reduce the prevalence of handoffs. In this study, we provided a quantitative analysis of physician stress by measuring the HRV of outgoing and oncoming physicians during patient handoffs. We recorded descriptive data of each observed patient handoff using the status of patient disposition as a measure of physician workload, and retrospectively gathered patient outcome and ED metric data for multivariate analysis. Results demonstrate that attending physicians experience increased HRV during handoff periods over non-handoff periods, with a significant increase observed in outgoing physicians (α = 0.05). This study creates a framework for future work that considers health care worker stress and evaluates ED handoffs via the stress and workload transferred between emergency physicians.

Safe handoff practices and improvement of communication in different paediatric settings

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.

Analysis ofMilitary-Civilian Patient Handoff at Vista Forge Multi-Agency Nuclear Disaster Exercise 2022.

The leadership of Vista Forge 2022 requested evaluation of the handoff process between military assets and civilian emergency medical services (EMS) providers by the Beth Israel Deaconess Fellowship in Disaster Medicine (BIDMF). Vista Forge was a multi-agency military-civilian full-scale disaster exercise coordinated by the U.S. Military. The exercise, held in Atlanta, Georgia, simulated response to a nuclear bomb in an urban setting by military and civilian disaster teams. BIDMF had several two-person teams who monitored handoff procedures between military assets after decontamination and civilian emergency medical services providers during the exercise evaluation. A verbal handoff between military and civilian entities was usually not done. Triage tags placed on mannequins before decontamination remained attached to the bodies and were sent with them to civilian hospitals. Triage tags were generic military forms without specific radiation or chemical exposure information. Not all decontamination groups had the same medical capabilities, and in a disaster it is unclear how these teams would manage medical emergencies. Future studies should develop a standardized handoff procedure to be used in mass casualty situations, and trial it in future multi-agency disaster exercises. Radiation specific triage tags should be considered.

Transferencia segura de pacientes y mejora de la comunicación en distintos entornos asistenciales

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardized handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimize communication and continuity of care in chronically ill and medically complex children.

Improving Handoffs in the Perioperative Environment: A Conceptual Framework of Key Theories, System Factors, Methods, and Core Interventions to Ensure Success.

Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events. The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ. Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.

Assessment of Gender Bias During Paramedic-Physician Handoffs.

Objective Gender bias against female physicians has been frequently demonstrated and associated with negative feelings toward their careers. Gender bias has also been demonstrated in prehospital clinical care. However, potential gender bias during paramedic-physician handoffs has not been studied. This study aimed to identify gender bias during interactions between prehospital personnel and emergency physicians at the time of patient handoff. Methods An observational study was conducted at an urban academic emergency department. Observers were trained to record information from paramedic-physician handoffs but were blind to the nature of the study. The primary outcome was to whom paramedics initially directed the focus of their handoff report based on physician gender, with secondary outcomes of to whom paramedics directed most of their report and whether they asked about further questions based on physician gender. Results There were 784 observed handoffs. There was no significant association between the gender of the physician and which physician received first attention (χ2{1, N = 782} = 0.9736, p = 0.3238) or majority attention (χ2{1, N = 780} = 1.9414, p = 0.1635). Paramedics were more likely to ask questions to male attendings than female attendings (χ2 {1, N = 784} = 4.4319, p = 0.0353). Conclusion We identified limited differences in communication based on gender between paramedics and physicians during emergency department patient handoffs.

Tools for care transfer in intensive care units: systematic review of observational studies

Objective: to evaluate the effectiveness of the use of tools for care transfer in patients admitted to an intensive care unit (ICU). Methods: Systematic review consulted in the databases PubMed, Embase, Cochrane Library, LILACS until August 2022. The descriptors “Patient Handoff”, “Continuity of Patient Care”, “SBAR”, “ISBAR”, “SBAR-R”, “ISBARR”, “ISOBAR”, “Communication” and “Intensive Care Units” were used. Observational studies use of any tools to transfer care in patients admitted to any ICU were included. Risk of bias using the Newcastle-Ottawa Scale. Results: the findings suggest that the professionals' perceptions are positive and that there was an improvement in multidisciplinary communication. As for the impact on patient care, the findings suggest that the use of transfer tools in care favors the complete completion of the medical record, as well as the notification of events in the medical records. Conclusions: no robust evidence was found regarding the use of ICU care transfer tools.

Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department.

Background There is a Registered Nurse (RN) shortage across the United States that is predicted to intensify in the upcoming years. RNs are an integral part of Emergency Departments (EDs) and perform many vital tasks, including IV placement, blood draws, medication administration, acute assessments, and patient hand-offs. Thus, RN staffing is a crucial part of ED operations, and ED initiatives should account for RN workforce shortages. Given the increase in ED visits and crowding, throughput initiatives that can expedite patient care are integral to the functioning of an ED. Team Triage is a throughput initiative that has been shown to improve ED time to provider, length of stay, and left without being seen rates. In our institution, we created a Team Triage model where advanced practice providers (APPs) perform a patient's initial evaluation in triage and place orders for labs, intravenous (IV) catheters, and imaging. Given the RN staffing shortage, we incorporated Licensed Practical Nurses (LPNs) in Team Triage to place IV catheters and draw blood work for laboratory tests. The objective of this investigation was to describe a Team Triage model that incorporated LPNs and to report the patient safety and productivity of this model. Methods This was a single-site retrospective study at a large, academic, tertiary care center with over 100,000 annual visits. Adult patients who self-presented to the ED and went through Team Triage (11 am-11 pm) between Jan 1, 2020, and Jan 31, 2020, were included in this study. LPNs staffed the Team Triage, along with APPs. LPNs placed IV catheters and drew blood specimens for the Team Triage patients. The primary outcomes studied were the proportion of specimens mislabeled by LPNs, the proportion of patients receiving IV catheters, the proportion of patients receiving blood work, blood tubes drawn per hour, and IVs inserted per hour in Team Triage. Results During the study period, 1355 patients went through Team Triage. Of these patients, 1075 (79%) were ordered for blood work, and 1017 (75%) were ordered for an IV catheter. All Team Triage blood work and IV catheter placements were completed by LPNs, who staffed 372 hours of Team Triage. A total of 2558 blood tubes were collected by LPNs. The LPNs cared for 2.9 patients per hour, collected 6.9 blood tubes per hour, inserted 2.7 IV catheters per hour, and collected 2.4 blood tubes per patient. The LPNs had a 0% specimen mislabeling rate. Conclusion Due to the significant RN workforce shortage impacting Emergency Medicine coupled with increased ED crowding, there is a significant need to evaluate the integration of LPNs into Team Triage to place IV catheters and perform blood draws. This study shows that incorporating LPNs in Team Triage is a productive and safe way to address nursing shortages in Emergency Medicine.

Patient handoffs and multi-specialty trainee perspectives across an institution: informing recommendations for health systems and an expanded conceptual framework for handoffs

BackgroundSafe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions.MethodsUsing a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees’ experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses.Results687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame.ConclusionsHealth systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment.

Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff

Study objectivesWe aimed to evaluate the duration and frequency of communication between EMS (Emergency Medical Services) and ED (Emergency Department) staff during handoff and the subsequent time to critical cardiac care (rhythm determination, defibrillation) using CA (cardiac arrest) video review. MethodsA single-center retrospective study of video-recorded adult CAs between August 2020 and December 2022 was performed. Two investigators assessed the communication of 17 data points, time intervals, EMS initiation of handoff, and type of EMS agency. Median times from initiation of handoff to first ED rhythm determination and defibrillation were compared between the groups above versus below the median number of data points communicated. ResultsOverall, 95 handoffs were reviewed. The handoff was initiated in a median of 2 seconds (interquartile range (IQR) 0–10) after arrival. EMS initiated handoff in 65 (69.2%) patients. The median number of data points communicated was 9 and median duration was 66 seconds (IQR 50–100). Age, location of arrest, estimated down time, and medications administered were communicated > 80% of the time, initial rhythm 79%, and bystander cardiopulmonary resuscitation and witnessed arrest < 50%. The median times from initiation of handoff to first ED rhythm determination and defibrillation were 188 (IQR 106–256) and 392 (IQR 247–725) seconds, though not statistically different between handoffs with <9 vs. ≥9 data points communicated (p > 0.40). ConclusionThere is no standardization for handoff reports from EMS to ED staff for CA patients. Using video review, we demonstrated the variable communication during handoff. Improvements to this process could reduce the time to critical cardiac care interventions.

Implementation of ED I-PASS as a Standardized Handoff Tool in the Pediatric Emergency Department.

Communication, failures during patient handoffs are a significant cause of medical error. There is a paucity of data on standardized handoff tools for intershift transitions of care in pediatric emergency medicine (PEM). The purpose of this quality improvement (QI) initiative was to improve handoffs between PEM attending physicians (i.e., supervising physicians ultimately responsible for patient care) through the implementation of a modified I-PASS tool (ED I-PASS). Our aims were to: (1) increase the proportion of physicians using ED I-PASS by two-thirds and (2) decrease the proportion reporting information loss during shift change by one-third, over a 6-month period. After literature and stakeholder review, Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) was implemented using iterative Plan-Do-Study-Act cycles, incorporating: trained "super-users"; print and electronic cognitive support tools; direct observation; and general and targeted feedback. Implementation occurred from September to April of 2021, during the height of the COVID-19 pandemic, when patient volumes were significantly lower than prepandemic levels. Data from observed handoffs were collected for process outcomes. Surveys regarding handoff practices were distributed before and after ED I-PASS implementation. 82.8% of participants completed follow-up surveys, and 69.6% of PEM physicians were observed performing a handoff. Use of ED I-PASS increased from 7.1% to 87.5% ( p < .001) and the reported perceived loss of important patient information during transitions of care decreased 50%, from 75.0% to 37.5% ( p = .02). Most (76.0%) participants reported satisfaction with ED I-PASS, despite half citing a perceived increase in handoff length. 54.2% reported a concurrent increase in written handoff documentation during the intervention. ED I-PASS can be successfully implemented among attending physicians in the pediatric emergency department setting. Its use resulted in significant decreases in reported perceived loss of patient information during intershift handoffs.