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Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver Driven Handoff Process Improvement
Journal article   Open access   Peer reviewed

Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver Driven Handoff Process Improvement

Kristina DeVore, Katherine Schneider, Elyse Laures, Alison Harmon and Paul Van Heukelom
Joint Commission journal on quality and patient safety, Vol.50(5), pp.363-370
01/2024
DOI: 10.1016/j.jcjq.2024.01.008
url
https://doi.org/10.1016/j.jcjq.2024.01.008View
Published (Version of record) Open Access

Abstract

Background Outpatient providers refer to emergency departments (ED) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS). Methods The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and utilization of EHR documentation. Process measures were collected via questionnaire pre- and post-implementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS. Results The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 pre-intervention to 2.04 post-intervention (p = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52; p = 0.04). Compliance with screening for referral to the ED was 84%. The proportion of patients who LWBS after referral decreased by 6.2 percentage points (p < 0.001). Conclusion Utilizing RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients who LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.

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