Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm
Abstract
Introduction
We aimed to assess the current scope of handoff education and practice among resident physicians in academic centers, and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED) to an inpatient setting.
Methods
This was a cross-sectional survey targeted at emergency medicine residency programs in the United States (US). The Web-based survey consisted of multiple choice, completion, and Likert scale items and was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff.
Results
121 of 172 allopathic and osteopathic programs responded to the survey, for an overall response rate of 70.3%. Our survey showed that most EM programs in the US have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system over seventy percent of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess handoff proficiency of trainees. Handoffs most commonly take place over the phone, though respondents disagreed about the ideal place for a handoff to occur with nearly equivalent responses between programs favoring the bedside, over the phone, or face to face at a computer station. Approximately 2/3 of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and review of the literature, we developed a five-step algorithm for the transition of care from the ED to an inpatient setting.
Conclusion
Our results identified current trends of education and practice in transitions of care from the ED to inpatient setting among US academic medical centers. An algorithm to guide this process is proposed to address the current gap in a standardized approach to ED to inpatient handoffs identified from the surveyed needs assessment.