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{
    "pk": 10886,
    "title": "Evaluation of a Novel Handoff Communication Strategy for Patients Admitted from the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction: \nMiscommunication during inter-unit handoffs between emergency and internal medicine physicians may jeopardize patient safety.  Our goal was to evaluate the impact of a structured communication strategy on the quality of admission handoffs.\nMethods: \nWe conducted a mixed-methods, pre-test/post-test study at a 560-bed academic health center with 60,000 emergency department (ED) patient visits per year. Admission-handoff best practices were integrated into a modified SBAR format, resulting in the Situation, Background, Assessment, Responsibilities & Risk, Discussion & Disposition, Read-back & Record (SBAR-DR) model. Physician handoff conversations were recorded and transcribed for the 60 days before (n=110) and 60 days after (n=110) introduction of the SBAR-DR strategy. Transcriptions were scored by two blinded physicians using a 16-item scoring instrument. The primary outcome was the composite handoff quality score. We assessed physician perceptions via a post-intervention survey.\nResults:\n The composite quality score improved in the post-intervention phase (7.57 + 2.42 vs. 8.45 + 2.51, p=.0085). Three of the 16 individual scoring elements also improved, including time for questions (70.6% vs. 82.7%, p=.0344) and confirmation of disposition plan (41.8% vs. 62.7%, p=.0019). The majority of emergency and internal medicine physicians felt that the SBAR-DR model had a positive impact on patient safety and handoff efficiency. \nConclusion:\n Implementation of the SBAR-DR strategy resulted in improved verbal handoff quality. Agreement upon a clear disposition plan was the most improved element, which is of great importance in delineating responsibility of care and streamlining ED throughput. Future efforts should focus on nurturing broader physician buy-in to facilitate institution-wide implementation.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "patient handoff"
        },
        {
            "word": "patent transfer"
        },
        {
            "word": "care transition"
        },
        {
            "word": "hosptial communication systems"
        }
    ],
    "section": "Patient Safety",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/34q743rd",
    "frozenauthors": [
        {
            "first_name": "Christopher",
            "middle_name": "J.",
            "last_name": "Smith",
            "name_suffix": "",
            "institution": "University of Nebraska Medical Center, Department of Internal Medicine, Omaha, Nebraska",
            "department": "None"
        },
        {
            "first_name": "Russell",
            "middle_name": "J.",
            "last_name": "Buzalko",
            "name_suffix": "",
            "institution": "Children’s Hospital & Medical Center, Omaha, Nebraska",
            "department": "None"
        },
        {
            "first_name": "Nathan",
            "middle_name": "",
            "last_name": "Anderson",
            "name_suffix": "",
            "institution": "University of Nebraska Medical Center, Department of Internal Medicine, Omaha, Nebraska",
            "department": "None"
        },
        {
            "first_name": "Joel",
            "middle_name": "",
            "last_name": "Michalski",
            "name_suffix": "",
            "institution": "University of Nebraska Medical Center, Department of Internal Medicine, Omaha, Nebraska",
            "department": "None"
        },
        {
            "first_name": "Jordan",
            "middle_name": "",
            "last_name": "Warchol",
            "name_suffix": "",
            "institution": "George Washington School of Medicine & Health Sciences, Department of Emergency Medicine, Washington, District of Columbia",
            "department": "None"
        },
        {
            "first_name": "Stephen",
            "middle_name": "",
            "last_name": "Ducey",
            "name_suffix": "",
            "institution": "Salt Lake Regional Medical Center, Department of Emergency Medicine, Salt Lake, Utah",
            "department": "None"
        },
        {
            "first_name": "Chad",
            "middle_name": "E.",
            "last_name": "Branecki",
            "name_suffix": "",
            "institution": "University of Nebraska Medical Center, Department of Emergency Medicine, Omaha, Nebraska",
            "department": "None"
        }
    ],
    "date_submitted": "2017-06-07T18:53:03Z",
    "date_accepted": "2017-06-07T18:53:03Z",
    "date_published": "2018-02-08T18:45:43Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10886/galley/5905/download/"
        }
    ]
}