Evaluation of a novel handoff communication strategy for patients admitted from the emergency department

Christopher J Smith, Russell J. Buzalko, Nathan Anderson, Joel Michalski, Jordan Warchol, Stephen Ducey, Chad E Branecki

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Miscommunication 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. Methods: We 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. Results: 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 ejficiency. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)372-379
Number of pages8
JournalWestern Journal of Emergency Medicine
Volume19
Issue number2
DOIs
StatePublished - Mar 2018

Fingerprint

Hospital Emergency Service
Communication
Physicians
Emergency Medicine
Patient Safety
Internal Medicine
Patient Handoff
Practice Guidelines
Health

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Evaluation of a novel handoff communication strategy for patients admitted from the emergency department. / Smith, Christopher J; Buzalko, Russell J.; Anderson, Nathan; Michalski, Joel; Warchol, Jordan; Ducey, Stephen; Branecki, Chad E.

In: Western Journal of Emergency Medicine, Vol. 19, No. 2, 03.2018, p. 372-379.

Research output: Contribution to journalArticle

Smith, Christopher J ; Buzalko, Russell J. ; Anderson, Nathan ; Michalski, Joel ; Warchol, Jordan ; Ducey, Stephen ; Branecki, Chad E. / Evaluation of a novel handoff communication strategy for patients admitted from the emergency department. In: Western Journal of Emergency Medicine. 2018 ; Vol. 19, No. 2. pp. 372-379.
@article{96e84dfa0c374766a9fe1d802cdeee7e,
title = "Evaluation of a novel handoff communication strategy for patients admitted from the emergency department",
abstract = "Introduction: Miscommunication 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. Methods: We 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. Results: 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 ejficiency. Conclusion: 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.",
author = "Smith, {Christopher J} and Buzalko, {Russell J.} and Nathan Anderson and Joel Michalski and Jordan Warchol and Stephen Ducey and Branecki, {Chad E}",
year = "2018",
month = "3",
doi = "10.5811/westjem.2017.9.35121",
language = "English (US)",
volume = "19",
pages = "372--379",
journal = "Western Journal of Emergency Medicine",
issn = "1936-900X",
publisher = "University of California",
number = "2",

}

TY - JOUR

T1 - Evaluation of a novel handoff communication strategy for patients admitted from the emergency department

AU - Smith, Christopher J

AU - Buzalko, Russell J.

AU - Anderson, Nathan

AU - Michalski, Joel

AU - Warchol, Jordan

AU - Ducey, Stephen

AU - Branecki, Chad E

PY - 2018/3

Y1 - 2018/3

N2 - Introduction: Miscommunication 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. Methods: We 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. Results: 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 ejficiency. Conclusion: 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.

AB - Introduction: Miscommunication 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. Methods: We 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. Results: 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 ejficiency. Conclusion: 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.

UR - http://www.scopus.com/inward/record.url?scp=85043341037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043341037&partnerID=8YFLogxK

U2 - 10.5811/westjem.2017.9.35121

DO - 10.5811/westjem.2017.9.35121

M3 - Article

C2 - 29560068

AN - SCOPUS:85043341037

VL - 19

SP - 372

EP - 379

JO - Western Journal of Emergency Medicine

JF - Western Journal of Emergency Medicine

SN - 1936-900X

IS - 2

ER -