To improve patient safety, The Joint Commission has called for standardization of physician–to–physician handoffs of patient information. The handoff from Emergency Medicine (EM) to Internal Medicine (IM) providers at the time of patient admission is high–risk, may pose unique challenges to standardization, and has never been characterized on a national level. We aimed to describe the structure, process, and perceived quality of EM–to–IM handoffs at university–based medical centers in the United States.
We contacted EM and IM residency program directors at all such centers, with contact information obtained from the American College of Physicians and Society for Academic Emergency Medicine websites or through administrative offices. 118 centers with both EM and IM training programs were identified. We asked these directors to identify the licensed physician in their respective departments most knowledgeable about the EM–to–IM transition of care. By this process, we had a total of 58 EM– and 60 IM–associated participants. We emailed them an anonymous 55–item survey using hypothetical scenarios of the most typical EM–to–IM handoffs, asking structured questions about the following broad domains: information transfer, transfer of responsibility during the admission process, and institutional characteristics. We explored perceptions of: time spent on the handoff, handoff and communication quality, potential errors or care delays, any existing policies, and provider responsibility at discrete handoff stages. We also solicited optional free–text comments.
76 (38 EM and 38 IM) of 118 (64%) physicians responded. They were experienced providers (mean 11 years in their role) and felt knowledgeable about the handoff. A majority noted problems with information transfer (78%) and unclear transfer of responsibility (59%) adversely affecting care quality. Most (86%) felt issues with information transfer had led to care delays. As to quality, only 32% rated communication as “excellent” or “outstanding”: more EM (44%) than IM (19%) providers did so, while more IM (19%) than EM (5%) providers rated the interaction as “poor.” Few centers had policies (11%) or offered training (15%) guiding information transfer. EM (37%) and IM (87%) providers significantly differed on the need for such guidelines, but most of all physicians (84%) agreed a policy of specific provider responsibility at each handoff stage should exist. Qualitative comments indicated the urgent need for more systematic handoff communication.
Academic centers widely vary in EM–to–IM handoff practices and policies. Handoff quality is perceived as suboptimal and patient care responsibility is often unclear, which may lead to miscommunication, errors, and patient harm. EM and IM providers have different perceptions of handoff quality and the need for a formal policy. Future studies should examine best practices for information transfer and ascribing patient care responsibility during this high–risk transition.