Waterfalls and Handoffs: A Novel Physician Staffing Model to Decrease Handoffs in a Pediatric Emergency Department.

Area of Science:

• Emergency Medicine
• Healthcare Management
• Patient Safety

Background:

• Patient handoffs during emergency department (ED) shift changes represent a significant risk to patient safety.
• While many strategies focus on improving handoff quality, few address reducing the frequency of handoffs.

Purpose of the Study:

• To evaluate a novel attending physician staffing model in an academic pediatric ED designed to decrease patient handoffs.
• To assess the impact of the new model on patient safety, provider efficiency, and workload balance.

Main Methods:

• A retrospective quality improvement study was conducted, analyzing 43,835 patient encounters.
• The original staffing model with multiple handoffs was replaced by overlapping "waterfall" shifts.
• Surveys were administered to attending physicians and charge nurses to gauge perceived effects of the change.

Main Results:

• The proportion of patient encounters involving handoffs decreased by 25%, from 7.9% to 5.9% immediately following implementation.
• Physician and charge nurse surveys indicated improvements in perceived patient safety, ED flow, and job satisfaction.

Conclusions:

• The implemented emergency physician staffing model, featuring overlapping shifts, effectively reduced the incidence of patient handoffs.
• This scalable, innovative staffing system is suitable for EDs with multiple physician coverage.