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AAP recommends standardized transition of care protocol for children in EDs
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A joint policy statement released by the AAP’s Committee on Pediatric Emergency Medicine encouraged EDs to implement and standardize approaches to transitions of care — “handoffs” or “sign-outs” — spanning the entire continuum of acute pediatric patient care.
Jointly issued with the American College of Emergency Physicians and Emergency Nurses Association, this policy statement addresses the obstacles and opportunities for error that can occur when responsibility for a patient’s care transfers between health care providers, especially in the acute care setting.
“Communication failures have been implicated as the root cause of more than 60% of sentinel events reported to The Joint Commission,” Toni K. Gross, MD, MPH, from the department of emergency medicine at Phoenix Children’s Hospital, and colleagues from the AAP committee wrote. “The Institute of Medicine report ‘To Err Is Human’ noted that 84% of treatment delays were later judged to be attributable to miscommunication, and 62% of these were continuum-of-care issues associated with shift changes.”
The researchers noted that while current transition of care practices have been criticized as inconstant, unstructured and prone to error, independent approaches have also been disparaged for fomenting adverse clinical outcomes, as well as inefficient or duplicative care.
The policy statement promotes the development of a standardized transition of care procedure for trainees within emergency medicine residency and fellowship programs, as well as nursing and allied health training programs. The researchers noted that with the start of hour limits for resident duty, more regular transitions of care in academic medicine increase the likelihood of safety concerns.
“A survey of emergency residency programs revealed that 75% had no formal didactic training and 90% had no written policy about [transitions of care],” Gross and colleagues wrote.
In addition to rationale for structuring transitions of care for children in the emergency setting, the policy statement provides recommendations for development, education and implementation of transition models, including:
- Protocols regarding transition of care should be standardized, with communication spanning the entire spectrum of acute patient care, such as prehospital care, ED shift changes, consultations with specialists, admitting patients to the hospital, as well as transferring care back to the medical home.
- Communication regarding transition of care should endeavor to be patient- or family-oriented, including patients (and their caregivers) at each transfer from one health care provider to the next.
- ED staff members should receive training and education on transition of care protocols during the implementation procedure at the institution.
- Trainees working in the ED should receive formal training and education on structured and consistent transition of care procedures; non-trainees should be offered training in transition of care protocols via maintenance of certification or continuing education activities.
- EDs providing care for children are encouraged to ally with local EMS agencies to develop a structured and consistent transition of care procedure.
- EDs providing care for children are encouraged to have interfacility transfer guidelines in place.
- EDs should encourage studies comparing transition of care models; standardized, validated process and outcome metrics are suggested to assess the efficacy of processes of care.
- Individual institutions should involve their IT department in the planning and implementation of structured and consistent transition of care procedures, as well as remain aware of developments in EHR technologies.
“Maintaining low rates of error and harm in this high-risk environment necessitates that any [transition of care] be accomplished in an effective, orderly, and predictable manner,” Gross and colleagues wrote. “It is important for a [transition of care] to reflect the multidisciplinary needs of ED patients, and the most favorable environment may include the presence of physician and nursing providers as well as other relevant ancillary staff to discuss [transition of care] information as a team.” – by Bob Stott
Disclosure: The researchers report no relevant financial disclosures.
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