• Christopher J Smith, Denise H Britigan, Elizabeth Lyden, Nathan Anderson, Ted J Welniak, and Michael C Wadman.
• Department of Internal Medicine, Division of General Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska.
• J Hosp Med. 2015 Nov 1; 10 (11): 711-7.

BackgroundEmergency department (ED) to inpatient physician handoffs are subject to complex challenges. We assessed physicians' perceptions of the ED admission handoff process and identified potential barriers to safe patient care.MethodsWe conducted a cross-sectional survey at a 627-bed tertiary care academic medical center. Eligible participants included all resident, fellow, and faculty physicians directly involved in admission handoffs from emergency medicine (EM) and 5 medical admitting services. The survey addressed communication quality, clinical information, interpersonal perceptions, assignment of responsibilities, organizational factors, and patient safety. Participants reported their responses via a 5-point Likert scale and an open-ended description of handoff-related adverse events.ResultsResponse rates were 63% for admitting (94/150) and 86% for EM physicians (32/37). Compared to EM respondents, admitting physicians reported that vital clinical information was communicated less frequently for all 8 content areas (P < 0.001). Ninety-four percent of EM physicians felt defensive at least "sometimes." Twenty-nine percent of all respondents reported handoff-related adverse events, most frequently related to ineffective communication. Sequential handoffs were common for both EM and admitting services, with 78% of physicians reporting they negatively impacted patient care.ConclusionPhysicians reported that patient safety was often at risk during the ED admission handoff process. Admitting and EM physicians had divergent perceptions regarding handoff communication, and sequential handoffs were common. Further research is needed to better understand this complex process and to investigate strategies for improvement.© 2015 Society of Hospital Medicine.

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