Being a patient admitted through the Emergency Department can be disorienting. Patients and family members who enter our EDs are typically sick, hurt, and scared. Throw in multiple interactions with a variety of caregivers, and remembering who they have seen, what tests were performed, and so on can be a daunting experience. Patient care handovers can also be risky for staff if treatment plans are not completely communicated or care orders are duplicated or omitted. That’s why proper and complete care transitions, also known as handovers, are so important.
Care transitions between the ED physician and hospitalist need to be collaborative and patient-centric. A great transition begins with outstanding communication between the care team members, which also includes the patient and family members. We recommend starting with the “why” by sharing with staff why we’re rolling this out, why it’s important, why it’s proven to be effective and so on. Providers and caregivers are busy people and want to know the benefits if they take on this new practice. The good news is, care transitions are proven to improve the quality and safety of patient care, reduce risk of litigation, and improve interactions with patients and family members.
It’s equally important to explain the process of care transitions to our patients. Ultimately as caregivers, it’s our job to help patients understand the role of this “inpatient specialist” and why their primary care doctor will not be caring for them while hospitalized.
We suggest following the below steps to effectively transition care of patients:
- Share this practice during your Emergency Department Stakeholder Team meeting and work out the specifics with your hospitalist team. Set a date to begin the new process.
- Agree in advance on the care transition/handover details. Create a standard template and require all individuals to adhere to that plan to avoid missing something. SBAR or similar formats work great for this. SBAR is a communication framework used by caregivers as an easy-to-remember mechanism for framing conversations that include patients. It stands for Situation, Background, Assessment, and Recommendation. At Studer Group, we suggest adding a “T” to SBART by adding “Thank” at the end (thanking the patient.)
- AIDET®, a communication framework developed by Studer Group, stands for Acknowledge, Introduce, Duration, Explanation and Thank You. These five behaviors are used in patient and family encounters to anticipate, meet, and exceed expectations and reduce the anxiety of the patient. When performed by the ED physician, AIDET® is very effective, especially when you manage up the expertise, experience, and role of the admitting hospitalist.
- We strongly recommend care transitions occur at the bedside. While we don’t want this practice to delay timely care transition to the floor, a face-to-face transition at the bedside, known as bedside shift report, is an excellent practice to hardwire for both care givers and patients. Just as we see benefits of bedside shift report elsewhere in the hospital, providing handovers in the presence of the patient alleviates fear, improves communication amongst the team, and provides a great opportunity for the patient and family to ask questions.
After a successful rollout of patient handovers from ED physicians to hospitalists, it’s important to validate that the care transition was safe and well-understood by the patient. One way to validate is through Leader Rounding. We recommend that Medical Directors of the Emergency Medicine and Hospital Medicine Services round together on five to six admitted patients per month (more if possible).
Leaders can validate that key behaviors and steps took place, including that patients described the communication that occurred before and during the handover to the inpatient floor. Leaders can also ask patients to provide key takeaways from the bedside shift report, and describe their specific plan of care. As with all rounding, there are also great opportunities to capture the names and specific actions to reward and recognize behavior.
Additional Resources:
- Dr. Dan Smith offers three scenarios of key individuals involved in ED – Hospitalist handovers in this insight.
- Looking to implement a successful hospitalist program? Learn best practices in this insight from Dr. Richard Rubin.
- See “what right looks like” during Emergency Department Excellence tracks at Studer Conferences.
- Advance Your Emergency Department: Leading in a New Era shares a wealth of tools and tactics that get results in the ED and across the entire organization.
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