The impact of physician handoffs on the outcomes of admitted emergency department patients: a medical administrative database retrospective cohort study
Notice bibliographique
Résumé
Abstract Introduction A 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. Methods We 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 Québec-Université 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. Results 21,136 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. Conclusion Emergency 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 subject Handoffs are widely believed to affect patient outcomes in the ED, although data remains scarce. What did this study ask What is the impact of handoffs between emergency physicians on patient outcomes What this study adds Handed 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.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».