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Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care.

Abstract：

STUDY OBJECTIVE:We identify, describe, and categorize vulnerabilities in emergency department (ED) to internal medicine patient transfers. METHODS:We surveyed all emergency medicine house staff, emergency physician assistants, internal medicine house staff and hospitalists at an urban, academic medical center. Respondents were asked to describe any adverse events occurring because of inadequate communication between emergency medicine and the admitting physician. We analyzed the open-ended responses with standard qualitative analysis techniques. RESULTS:Of 139 of 264 survey respondents (53%), 40 (29%) reported that a patient of theirs had experienced an adverse event or near miss after ED to inpatient transfer. These 40 respondents described 36 specific incidents of errors in diagnosis (N=13), treatment (N=14), and disposition (N=13), after which patients experienced harm or a near miss event. Six patients required an upgrade in care from the floor to the ICU. Although we asked respondents to describe communication failures, analysis of responses identified numerous contributors to error: inaccurate or incomplete information, particularly of vital signs; cultural and professional conflicts; crowding; high workload; difficulty in accessing key information such as vital signs, pending data, ED notes, ED orders, and identity of responsible physician; nonlinear patient flow; "boarding" in the ED; and ambiguous responsibility for sign-out or follow-up. CONCLUSION:The transfer of a patient from the ED to internal medicine can be associated with adverse events. Specific vulnerable areas include communication, environment, workload, information technology, patient flow, and assignment of responsibility. Systems-based interventions could ameliorate many of these and potentially improve patient safety.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Horwitz LI,Meredith T,Schuur JD,Shah NR,Kulkarni RG,Jenq GY

doi

10.1016/j.annemergmed.2008.05.007

subject

Has Abstract

pub_date

2009-06-01 00:00:00

pages

701-10.e4

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(08)00795-6

journal_volume

pub_type

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Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care.