The impact of physician handoffs on the outcomes of admitted emergency department patients: a medical administrative database retrospective cohort study

IntroductionA physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes. MethodsWe included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Quebec-Universite Laval during fiscal year 2016-17. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted propensity score based analysis accounting for patient and hospital clusters and adjusting for demographics, multiple disease severity indicators and ED processes indicators, including crowding. Results21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In propensity score analysis (OR handoff/no handoff [CI95%] or GMR[Cl95%]), handoff status was not associated with mortality (1.08[0.93,1.26]), ICU admission (1.01[0.87,1.18]) or hospital length of stay (1.02[0.94-1.10]). Sensitivity and sub-group based analyses yielded no further information. ConclusionEmergency physicians handoffs were not associated with an increase in risk of severe in-hospital adverse events. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity. What is already known on this subjectHandoffs are widely believed to affect patient outcomes in the ED, although data remains scarce. What did this study askWhat is the impact of handoffs between emergency physicians on patient outcomes What this study addsHanded off patients do not seem to do worse than non handed off patients concerning majors outcomes (mortality, ICU admission, LOS). Why does it matter to clinicians?In the ED, handoffs may not represent a risk to patient outcomes. QI efforts may be better invested in other care inefficiencies.