Reducing Error in the Emergency Department: A Call for Standardization of the Sign-out Process

University of California, Davis School of Medicine, Department of Emergency Medicine, Sacramento, CA, USA.
Annals of emergency medicine (Impact Factor: 4.68). 03/2010; 56(6):637-42. DOI: 10.1016/j.annemergmed.2010.02.004
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    • "Handover and transition of patients have become focuses of efforts towards reducing errors. Up to 50% of errors in communication occur during hand-off [9,10]. Thus, patient hand-offs at shift changes in an ED are an important safety process and a critical moment [11]. "
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    ABSTRACT: Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.
    BMC Health Services Research 07/2014; 14(1):296. DOI:10.1186/1472-6963-14-296 · 1.71 Impact Factor
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    ABSTRACT: This document reviews the full collection of literature on hospital handoffs and is referenced by shorter publications. Researchers may see abstracts at . Access to the full text of the articles may be requested by contacting the authors. Background: In hospitals, handoffs are episodes in which control of, or responsibility for, a patient passes from one health professional to another, and in which important information about the patient is also exchanged. In view of the growing interest in improving handoff processes, and the need for guidance in arriving at standardized handoff procedures, a review of the research on handoffs is provided. Methods: The authors have attempted to identify all research treatments of hospital handoffs involving medical personnel published in English through July 2008. Results: Findings from the literature are organized into six themes: 1) The definition of 'handoff'; 2) The functions of handoffs; 3) The challenges and difficulties of handing off; 4) The costs and benefits of standardization; 5) Possible protocols for standardizing of handoffs; and 6) Questions needing answers, and methods of research. Conclusions: The large body of relevant literature shows handoff to be highly sensitive to variations in context, to be an activity that is essential for multiple important functions within a hospital that range far beyond patient safety, and to be subject to difficult tensions that necessarily attend efforts to standardize action within a highly differentiated hospital setting. In addition, there is little empirical evidence regarding the magnitude of the impact of handoff on patient safety and service quality, making the potential gains and complications from standardization uncertain. Robert Wood Johnson Foundation
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