Streamlining Telecommunications Center and Interfacility Patient Throughput to a Pediatric Emergency Department by Utilizing an Electronic Handoff: A Quality Improvement Initiative.

OBJECTIVE: Effective handoffs are critical for patient safety and high-quality care. The pediatric emergency department serves as the initial reception for patients where optimal communication is crucial. The complexities of interfacility handoffs can result in information loss due to lack of standardization. The aim of our project was a 50% reduction in monthly calls routed through the communication center from 157 to 78, for interfacility transfers to the emergency department from outpatient sites within our organization over a 1-year period, through utilization of an electronic handoff activity.

METHODS: We designed a quality improvement project in a tertiary care pediatric hospital to improve the process of interfacility transfer. The initiative aimed to streamline the transfer of patients from ambulatory, urgent care, and nurse triage encounters to the pediatric emergency department by using the electronic health record. The primary outcome measure was number of monthly calls received by the telecommunications center for these transfers.Our process measure was tracked by measuring the utilization of the electronic handoff. In addition, the number of safety events reported because of information lost through using the electronic handoff served as a balancing measure.

RESULTS: One year after the enterprise-wide rollout of the handoff, the telecommunications center was receiving an average of 29 calls per month versus 157 at time of study initiation, a decrease of 81.5%. Monthly usage increased from zero to an average of 544 during the same period. The project was continued after the initial 12-month data collection and demonstrated stability.

CONCLUSIONS: Our initiative facilitated the safe and efficient transfer of patients and streamlined workflows without sacrificing quality of patient care. Our telecommunications center has been freed up for other tasks with fewer interruptions during patient throughput. Next steps will analyze the encounters of transferred patients to further optimize patient flow at our organization.