23 Turn That Frown Upside Down: Implementation of a Visual Cue Improves Communication During Emergency Department Inpatient Handoffs

BackgroundWhen a patient is admitted to the hospital from the emergency department (ED), their care is transitioned from the emergency physician (EP) to the inpatient physician. This care transition is called a “handoff” and signals that responsibility for the patient has shifted to the admitting team. “Calling report,” or communication between care teams, ensures that patient information, results of diagnostic studies, and patient status are seamlessly communicated with the admitting team. It alerts the team of the patient’s condition and need for ongoing treatment or workup. Failure to consistently perform patient handoffs from the ED to the inpatient unit creates a lapse in patient care and could have a negative impact on patient safety. In the pre-intervention state at our institution, our electronic health record (EHR) was designed with a “report called” button for the EP to click after calling report to the inpatient team. This button was located inside the patient chart, and the chart had to be opened before the physician could click. Additionally, once clicked, users had to change screen views in order to see the “Y” for yes or the “N” for no. This mechanism did not fit well into either physician or nursing workflows and was often overlooked. Patients might be transported to the floor without physician report being called, leading to poor communication and the potential for patient safety errors.Study ObjectivesOur primary outcome was to enhance visibility of a new communication signal to improve compliance with doc-to-doc communication prior to transporting the patient to the floor. Our secondary outcome was to evaluate the report called button’s impact on patient safety in ED to inpatient admissions.MethodsWe developed a visual cue on the track board to alert nursing staff that doc-to-doc report had been called. When an inpatient bed is requested, the EMR automatically produces a red icon on the trackboard (Figure). This icon alerts the EP and RN that a bed has been requested, but that report is not yet called. When doc-to-doc report is called, the EP clicks on the icon and changes the icon to green, signaling that report has been done and the patient is ready for transport.ResultsThe baseline compliance for the “report called” button being appropriately clicked before implementation of our intervention was 26%. In the three months prior to the intervention, there were three “near misses” where patients were transported to the floor before report had been called, resulting in poor communication and the potential for patient safety issues. In the three months after our intervention, report called compliance was 98.9% and there were zero patients transported to the floor before report was called.Conclusion BackgroundWhen a patient is admitted to the hospital from the emergency department (ED), their care is transitioned from the emergency physician (EP) to the inpatient physician. This care transition is called a “handoff” and signals that responsibility for the patient has shifted to the admitting team. “Calling report,” or communication between care teams, ensures that patient information, results of diagnostic studies, and patient status are seamlessly communicated with the admitting team. It alerts the team of the patient’s condition and need for ongoing treatment or workup. Failure to consistently perform patient handoffs from the ED to the inpatient unit creates a lapse in patient care and could have a negative impact on patient safety. In the pre-intervention state at our institution, our electronic health record (EHR) was designed with a “report called” button for the EP to click after calling report to the inpatient team. This button was located inside the patient chart, and the chart had to be opened before the physician could click. Additionally, once clicked, users had to change screen views in order to see the “Y” for yes or the “N” for no. This mechanism did not fit well into either physician or nursing workflows and was often overlooked. Patients might be transported to the floor without physician report being called, leading to poor communication and the potential for patient safety errors. When a patient is admitted to the hospital from the emergency department (ED), their care is transitioned from the emergency physician (EP) to the inpatient physician. This care transition is called a “handoff” and signals that responsibility for the patient has shifted to the admitting team. “Calling report,” or communication between care teams, ensures that patient information, results of diagnostic studies, and patient status are seamlessly communicated with the admitting team. It alerts the team of the patient’s condition and need for ongoing treatment or workup. Failure to consistently perform patient handoffs from the ED to the inpatient unit creates a lapse in patient care and could have a negative impact on patient safety. In the pre-intervention state at our institution, our electronic health record (EHR) was designed with a “report called” button for the EP to click after calling report to the inpatient team. This button was located inside the patient chart, and the chart had to be opened before the physician could click. Additionally, once clicked, users had to change screen views in order to see the “Y” for yes or the “N” for no. This mechanism did not fit well into either physician or nursing workflows and was often overlooked. Patients might be transported to the floor without physician report being called, leading to poor communication and the potential for patient safety errors. Study ObjectivesOur primary outcome was to enhance visibility of a new communication signal to improve compliance with doc-to-doc communication prior to transporting the patient to the floor. Our secondary outcome was to evaluate the report called button’s impact on patient safety in ED to inpatient admissions. Our primary outcome was to enhance visibility of a new communication signal to improve compliance with doc-to-doc communication prior to transporting the patient to the floor. Our secondary outcome was to evaluate the report called button’s impact on patient safety in ED to inpatient admissions. MethodsWe developed a visual cue on the track board to alert nursing staff that doc-to-doc report had been called. When an inpatient bed is requested, the EMR automatically produces a red icon on the trackboard (Figure). This icon alerts the EP and RN that a bed has been requested, but that report is not yet called. When doc-to-doc report is called, the EP clicks on the icon and changes the icon to green, signaling that report has been done and the patient is ready for transport. We developed a visual cue on the track board to alert nursing staff that doc-to-doc report had been called. When an inpatient bed is requested, the EMR automatically produces a red icon on the trackboard (Figure). This icon alerts the EP and RN that a bed has been requested, but that report is not yet called. When doc-to-doc report is called, the EP clicks on the icon and changes the icon to green, signaling that report has been done and the patient is ready for transport. ResultsThe baseline compliance for the “report called” button being appropriately clicked before implementation of our intervention was 26%. In the three months prior to the intervention, there were three “near misses” where patients were transported to the floor before report had been called, resulting in poor communication and the potential for patient safety issues. In the three months after our intervention, report called compliance was 98.9% and there were zero patients transported to the floor before report was called. The baseline compliance for the “report called” button being appropriately clicked before implementation of our intervention was 26%. In the three months prior to the intervention, there were three “near misses” where patients were transported to the floor before report had been called, resulting in poor communication and the potential for patient safety issues. In the three months after our intervention, report called compliance was 98.9% and there were zero patients transported to the floor before report was called. Conclusion