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: 4.33). 03/2010; 56(6):637-42. DOI: 10.1016/j.annemergmed.2010.02.004
Source: PubMed
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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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    ABSTRACT: With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.
    Academic medicine: journal of the Association of American Medical Colleges 02/2012; 87(4):403-10. DOI:10.1097/ACM.0b013e318248e5c2 · 3.47 Impact Factor
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