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Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
Kathleen Huth1, Anne M Stack2, Jonathan Hatoun3
1Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA kathleen.huth@childrens.harvard.edu.
BMJ Quality & Safety
|April 18, 2020
Summary
A structured handoff intervention significantly improved patient care transfers from clinics to the emergency department (ED). This receiver-driven approach enhanced communication, reduced medical errors, and boosted perceived quality, safety, and efficiency.
Area of Science:
- Medical error reduction
- Healthcare communication systems
- Patient transfer protocols
Background:
- Miscommunications during patient care transfers are a major cause of medical errors.
- Standardized information transfer recommendations from outpatient clinics to the emergency department (ED) lack formal evaluation.
- Need to assess receiver-driven interventions for improving clinic-to-ED handoffs.
Purpose of the Study:
- To evaluate a receiver-driven structured handoff intervention.
- Assess impact on standardized element inclusion, miscommunications, and perceived quality, safety, and efficiency.
Main Methods:
- Prospective intervention study in a pediatric ED and affiliated clinics (2016-2018).
- Bundled handoff intervention: standard template, receiver training, awareness campaign, iterative feedback.
- Assessed audio-recorded handoffs and medical records for standardized elements and miscommunications; surveyed stakeholders pre/post-intervention.
Main Results:
- Intervention significantly increased inclusion of key elements: illness severity (46% to 77%), pending tests (0% to 64%), contingency plans (0% to 54%), and synthesis (2% to 73%).
- Miscommunications decreased by 23% (48% to 26%).
- Perceptions of quality (35% to 59%), safety (43% to 73%), and efficiency (17% to 72%) improved significantly.
Conclusions:
- A receiver-driven intervention for clinic-to-ED handoffs improves communication quality.
- Findings support expanded implementation to enhance care for patients transferred to pediatric EDs.
- Structured handoffs are crucial for patient safety and efficient healthcare delivery.
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