Improving Interunit Transitions of Care Between Emergency Physicians and Hospital Medicine Physicians: A Conceptual Approach

Authors

  • Christopher Beach MD,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Dickson S. Cheung MD, MBA, MPH,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Julie Apker PhD,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Leora I. Horwitz MD, MHS,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Eric E. Howell MD,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Kevin J. O’Leary MD,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Emily S. Patterson PhD,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Jeremiah D. Schuur MD, MHS,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Robert Wears MD,

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • Mark Williams MD

    1. From the Department of Emergency Medicine (CB) and Division of Hospital Medicine (KJO, MW), Northwestern University–The Feinberg School of Medicine, Chicago, IL; Sky Ridge Medical Center, Carepoint, P.C. (DSC), Denver, CO; the School of Communication, Western Michigan University (JA), Kalamazoo, MI; the Section of General Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation (LIH), New Haven, CT; the Division of Collaborative Inpatient Medicine Service, Johns Hopkins Medical Institutions (EEH), Baltimore, MD; the School of Allied Medical Professions, College of Medicine, Ohio State University (ESP), Columbus, OH; the Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School (JDS), Boston, MA; and the Department of Emergency Medicine, University of Florida (RW), Jacksonville, FL.
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  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Lawrence Lewis, MD.

Address for correspondence and reprints: Christopher Beach, MD; e-mail: cbeach@nmff.org.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:1188–1195 © 2012 by the Society for Academic Emergency Medicine

Abstract

Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care.

Abstract

Resumen

Las transiciones en la atención del paciente entre distintas especialidades son más complejas que entre la misma especialidad, pero las características técnicas y sociales permanecen sin explorar. Todavía existe poco consenso entre los investigadores y los médicos sobre las estrategias para mejorar la comunicación entre especialidades. Este artículo conceptual aborda este vacío y focaliza en el proceso del pase entre los urgenciólogos y los médicos de medicina del hospital. La sensibilidad a las diferencias culturales y operativas y una serie común de ideas concernientes al contenido del pase preparará de forma más efectiva al próximo médico para actuar de forma segura y eficiente en la atención del paciente. A través de un consenso en el proceso de toma de decisiones entre autoridades reconocidas y experimentadas en transiciones sanitarias, que incluye médicos de ambas especialidades y expertos en estudios de comunicación, se proponen unos principios de contenido y de estilo que los clínicos pueden usar para mejorar la comunicación de la transición. Con representación de los escenarios universitario y comunitario, las similitudes y diferencias entre la medicina de urgencias y emergencias y la medicina interna se destacan para realzar la apreciación de valores, actitudes y objetivos de cada especialidad, particularmente en lo perteneciente a la comunicación. También se evalúan los diferentes medios de comunicación, los comportamientos sociales y culturales, y las herramientas que los médicos utilizan para compartir la información sobre la atención del paciente. Se proponen medidas de calidad en la estructura, el proceso y los resultados para las instituciones que buscan evaluar y monitorizar estrategias de mejora en la realización del pase de pacientes. Serán necesarios futuros estudios de validación para determinar si estas mejoras sugeridas en la comunicación del pase resultan en la mejora de los resultados del paciente. Mediante la exploración de las dinámicas de la comunicación de la transición entre especialidades y sugiriendo prácticas mejores se espera reforzarlas tareas del pase y contribuir a mejorar la continuidad de los cuidados.

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