Best Practices for Emergency Department Patient Handoffs
Provide a written handoff with all pertinent information included is the recommended best practice, ideally conducted at the bedside using a standardized communication tool. 1, 2, 3
Core Components of Effective ED Handoffs
Use Standardized Communication Tools
- Implement a standardized reporting system (such as SBAR: Situation, Background, Assessment, Recommendation) to structure handoff communication. 1, 3, 4
- Standardized tools reduce patient length of stay by approximately 32 minutes and improve ED throughput efficiency. 2
- Despite strong evidence, fewer than 20% of emergency departments currently use standardized handoff tools. 5
Conduct Handoffs at the Bedside
- Perform handoffs at the patient's bedside rather than at the desk to prevent loss of critical information and enable visual assessment. 3, 4
- Bedside handoffs increased from 45% to 85% compliance when combined with standardized reporting systems, with associated improvements in patient outcomes. 2
- ED nurses specifically identify bedside handoffs as essential for maintaining continuity of care and preventing information gaps. 4
Essential Information to Include
Patient identification and presenting problem:
- Current condition summary and chief complaint 4
- Time of symptom onset or last known well time (critical for time-sensitive conditions like stroke) 1
Treatment and clinical status:
- Medications administered and current medication list 1, 4
- Vital signs and nursing observations 4
- Treatment plan and interventions completed 4
Pending work and disposition:
- Outstanding laboratory results and imaging studies 5
- Future care needs and disposition plan 4
- Identification of "high-risk" patients requiring special attention 5
Critical background information:
- Relevant medical history and current health conditions 1
- Anticoagulation status (particularly important for stroke patients) 1
- Family contact information and decision-maker accessibility 1
Implementation Strategies
Minimize Interruptions
- Designate uninterrupted time specifically for handoffs to prevent communication errors. 5
- Communication failures from inadequate handoffs remain among the most common factors contributing to adverse events. 1
Provide Written Documentation
- Use electronic medical records during handoff to reference and verify information. 3
- Written handoffs ensure all pertinent information is captured and accessible. 5
Training and Standardization
- Provide formal handoff training for both residents and attending physicians. 5
- Only one-third of residency programs currently provide formal handoff training despite its critical importance. 5
Common Pitfalls to Avoid
Avoid desk-only handoffs:
- Performing handoffs exclusively at the desk increases delays in patient care and prevents visual patient assessment. 2, 3
- Desk handoffs are associated with longer patient length of stay compared to bedside handoffs with standardized tools. 2
Don't include excessive historical detail:
- Comprehensive social, medication, and family history should be available in documentation but not necessarily verbalized during every handoff. 4
- Focus on information directly relevant to immediate care needs and pending decisions. 5, 4
Avoid informal, unstructured communication:
- Unstructured handoffs lead to omission of critical information including medications, vital signs, and nursing care needs. 4
- Standardized approaches prevent these gaps and improve information transfer accuracy. 2, 3
Special Considerations for High-Risk Patients
Stroke patients require specific handoff elements:
- Exact time of symptom onset or last known well time 1
- Current anticoagulation status 1
- Glasgow Coma Scale score and triage level 1
- Expected time of arrival for incoming patients 1
Pediatric patients need additional considerations: