Transitions of Care

Transitions of Care

September 15, 2020

Transitions of care are one of the most dangerous activities in medicine. Numerous studies highlight the rates of medical errors which occur at the time of sign-outs. Formalized sign-out processes have been shown to significantly decrease breakdowns in communication and reduce adverse events. In this episode, Dr. Kaminsky sits down with residents from across the country to dissect and discuss different sign-out styles and share some insights regarding bias and areas for improvement.

iTunes

Listen on Google Play Music

Spotify

Pandora

iHeartRadio

Amazon Music

Audible

Host

Alexander Kaminsky, MD

University of California San Francisco – Fresno
PGY4
@Alex_KamskyEM
EMRA*Cast Episodes

Guests

Rosemarie Diaz, MD

University of Michigan

Mary McLean, MD

St. John's Riverside Hospital
Twitter: @marymclean85

Nicholas Robbins, MD

John Peter Smith Hospital
Twitter: @EMResGrandpa

Overview:

Transitions of care are one of the most dangerous activities in medicine. Numerous studies highlight the rates of medical errors which occur at the time of sign-outs. Formalized sign-out processes have been shown to significantly decrease breakdowns in communication and reduce adverse events. In this episode, Dr. Kaminsky sits down with residents from across the country to dissect and discuss different sign-out styles and share some insights regarding bias and areas for improvement.

Key Resources:

Key Points:

  • In a prospective multi-center study (>10,000 patients) communication error occurred at a rate pf 24.5 per 100 admissions. Preventable errors were found to be 4.7 per 100 admissions.
  • Effective sign-out strategies have been shown to reduce overall medical errors by ~23% and preventable adverse events by ~30%.

Hand-Off Tools:

Remember CODE STATUS!

IPASS: 

Illness severity: Stable, “watcher,” unstable

Patient Summary: HPI, ED course/Ongoing assessment, Plan

Action List: “To-do”

Situation Awareness and Contingency Planning: “If this, then do that.” Give your colleagues an idea of what to do if an event occurs.

Synthesis by Receiver: Person taking the sign out does a “readback” of what they heard. Restate key actions. Also, the time to ask questions.

SBAR

Situation: Clearly and briefly define the situation

Background: Provide clear, relevant background information that relates to the situation. 

Assessment: A statement of your professional conclusion. 

Recommendation: What do you need from this individual? What to do and contingencies.

SHOUT

S: Sick or not Sick

H: History and Hospital Course 

O: Objective Data 

U: Upcoming plan, disposition

T: To do

 (note: This is by no means a comprehensive list)

References:

  1. Brady P, Gorham J, Kosti A, et al "SHOUT" to improve the quality of care delivered to patients with acute kidney injury at Great Western Hospital. BMJ Open Quality 2015;4:u207938.w3198. doi: 10.1136/bmjquality.u207938.w3198
  2. “SBAR a Powerful Tool to Help Improve Communication.” The Joint Commission, www.jointcommission.org/resources/news-and-multimedia/blogs/at-home-with-the-joint-commission/2013/11/sbar--a-powerful-tool-to-help-improve-communication/?_ga=2.175033826.1924301882.1600033523-2075193987.1600033523. 
  3. Starmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371(19):1803-12.
  4. Heilman JA, Flanigan M, Nelson A, Johnson T, Yarris LM. Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs. West J Emerg Med. 2016;17(6):756-61.
  5. Cheung DS, Kelly JJ, Beach C, Berkeley RP, Bitterman RA, Broida RI, et al. Improving handoffs in the emergency department. Ann Emerg Med. 2010;55(2):171-80.

Related Content

Oct 14, 2020

EMRA*Cast & EMRA Critical Care Committee Journal Club

Fluid resuscitation in sepsis is a hotly debated and much-studied topic - and for good reason. Listen in as three emergency physicians discuss some of the landmark papers directing emergency care of these critically ill patients. Join host Dr. Ranjita Raghavan of Mount Sinai and guests Dr. Chad Meyers of Elmhurst Hospital Center and Dr. Dustin Slagle of ChristianaCare.

Oct 14, 2020

Aging in the ER: Geriatric Emergency Medicine

This topic never gets old! Whether you realize it or not, geriatrics is probably a large part of your practice especially when it comes to high-complexity, high-acuity emergency medicine. Dr. Lauren Southerland will teach us what we can do to better care for older adults. We'll also discuss how to get involved at the national level and how to pursue a career in geriatric EM if you want to go a step further.

Oct 14, 2020

Hot Topics: Climate Change, Health Policy, and Emergency Medicine

How do rising temperatures affect emergency medicine and the health of your patients? What do bugs, drugs, plants, and people have to do with climate change? Dr. Caitlin Rublee explains how to connect these dots and engage in health policy to protect patients.