Emergency Physician to Admitting Physician Handovers: An Exploratory Study

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Abstract
Current emphasis on the number of deaths due to medical errors has pushed the patient safety issue to the forefront at many medical institutions. The Institute of Medicine's recommendation for improved coordination and collaboration between physicians, as well as the paucity of related literature, has led the authors to explore the nature of the handover between emergency department and admitting physicians. Research was conducted at two Ohio hospitals to document the phases and issues found in emergency department (ED) handovers. The phases for ED handovers were similar to those found in shift changes in other types of industries (e.g., paper mill, air traffic control) with minor variations in the order of the phases. Three areas were identified where potential errors could occur including the spoken communication between physicians, selection of diagnostic tests based on the specific admitting physician, and the use of surrogates by the admitting physician. Physicians identified the level of trust in ED resident physicians, incomplete handovers between ED physicians at their shift change, differences in exams and treatment plans based on admitting physician, and notification of possible admission prior to receiving results for exams as potential problem areas. The findings of this research illustrate the need for future research into physician communication. These studies have tremendous opportunity to enable the Institute of Medicine's goal of improving communication between physicians for better patient care and outcomes.