Related Experiment Video
Updated: Dec 30, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Attending-Provider Handoffs and Pediatric Emergency Department Revisits
Todd W Lyons, Kenneth A Michelson1, Lise E Nigrovic1
1From the Division of Emergency Medicine, Boston Children's Hospital; Department of Pediatrics Harvard Medical School.
Insights
Provider handoffs in pediatric emergency departments (EDs) did not increase the risk of return ED visits resulting in hospitalization. This study found no association after adjusting for patient and visit factors.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Patient Safety
Background:
- Transitions of care, or handoffs, between attending providers are common in pediatric emergency departments (EDs).
- Understanding the impact of these handoffs on patient outcomes is crucial for improving care quality.
Purpose of the Study:
- To investigate the association between intradepartment attending-provider handoffs during pediatric ED encounters and subsequent return ED visits.
- To determine if these handoffs correlate with return visits resulting in hospitalization or with potential care deficiencies.
Main Methods:
- Analysis of 177,350 pediatric ED encounters from January 2013 to February 2017.
- Classification of encounters based on whether the initial and discharging attending providers differed (handoff).
- Comparison of outcomes (return visits within 72 hours, with or without hospitalization) between encounters with and without handoffs, with statistical adjustments.
Main Results:
- Unadjusted analyses showed a higher likelihood of return visits with hospitalization for encounters with handoffs (OR 1.46).
- However, after adjusting for demographic, clinical, and visit characteristics, provider handoffs were not significantly associated with return ED visits resulting in hospitalization (OR 0.96).
- Similarly, adjusted analyses found no association between handoffs and any return ED visits (OR 1.00).
Conclusions:
- Intradepartment attending-provider handoffs within a pediatric ED setting do not appear to increase the risk of return visits requiring hospitalization.
- The study suggests that after accounting for relevant factors, handoffs are not a significant predictor of adverse return visit outcomes.
Objective:
The objective of this study was to determine if intradepartment attending-provider transitions of care (handoffs) during a pediatric emergency department (ED) encounter were associated with return ED visits resulting in hospitalization.
Methods:
We analyzed ED encounters for patients younger than 21 years discharged from a single pediatric ED from January 2013 to February 2017. We classified an encounter as having a handoff when the initial attending and discharging attending differed. Our primary outcome was a revisit within 72 hours resulting in hospitalization. Our secondary outcomes were any revisit within 72 hours and revisits resulting in hospitalization with potential deficiencies in care. We compared outcome rates for ED encounters with and without provider handoffs, both with and without adjustment for demographic, clinical, and visit characteristics.
Results:
Of the 177,350 eligible ED encounters, 1961 (1.1%) had a return visit resulting in hospitalization and 6821 (3.9%) had any return visit. In unadjusted analyses, handoffs were associated with an increased likelihood of a return visit resulting in hospitalization (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.26-1.70) or any return visit (OR, 1.20; 95% CI, 1.10-1.31). However, after adjustment, provider handoffs were not associated with return ED visits resulting in hospitalization (OR, 0.96; 95% CI, 0.81-1.13) or any return ED visits (OR, 1.00; 95% CI, 0.90-1.10).
Conclusions:
Provider handoffs in a pediatric ED did not increase the risk of return ED visits or return ED visits with deficiencies in care after adjustment for demographic, clinical, and visit factors.
Related Concept Videos
01:25Types of Reports I: Hands-off Report
Following are the key components and categories of hand-off reports:
Purpose and Process:
01:29SBAR I: Understanding the Concept
Standardized methods of communication have been developed to ensure that information is...
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:26Types of Reports III: Telephone and Verbal Reports
Here's an overview of each type:
Telephone Orders
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...