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Interdisciplinary mistrust, communication breakdowns cited in survey of ED handoffs.

Both emergency and inpatient physicians agree that miscommunication during interunit handoffs can compromise patient care and that sequential handoffs are particularly problematic, according to a new study conducted at the University of Nebraska Medical Center (UNMC) in Omaha, NE. The study highlights physician survey data showing that there is mistrust between inpatient and emergency physicians, and that which provider is responsible for patient care can be unclear when a verbal handoff is made. To make improvements, UNMC has been piloting a tool aimed at standardizing verbal and written handoff communications. Nearly a third of all the participating physicians surveyed reported having handoff-related adverse events, and most put the blame on ineffective communication. Ninety-four percent of emergency physicians surveyed indicated that they had to defend their clinical decisions at least some of the time. The admitting physicians largely validated this concern, with more than 25% noting that they usually disagree with decisions made in the ED. Using the situation, background, assessment, recommendation (SBAR) form of communication as a starting point, an intervention tool aims to streamline handoff communications, both verbally and in the electronic medical record.