Handoffs: Why hospitalists and ED doctors “drop the baton”

From Today’s Hospitalist:

“No sign-out was given on the patient. When nursing staff called me to evaluate, patient was tachypneic and tachycardic. Patient was transferred to CCU with acute coronary syndrome. ED stated that this was an error secondary to being very busy with crowding in ED.”

Sound familiar? Given all the communication problems between ED physicians and hospitalists, it’s no wonder that both groups stereotype the other: Hospitalists complain that ED staff lack professionalism and judgment. Hospitalists, counter the ED doctors, expect too much.

Researchers who looked at transfers between the ED and the medical service in an urban academic center were surprised to find that problems went far beyond inaccurate or incomplete vital-sign information. Instead, they say it’s more often about system flaws—overcrowding, high workload and lagging technology—that intensify the pressure.

In a study titled “Dropping the Baton”, published online in June by Annals of Emergency Medicine, 40 respondents described 36 specific incidents of errors in diagnosis, treatment and disposition that caused patients harm or a near miss.