Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine

Kamna S. Balhara, Susan M. Peterson, Mohamed Moheb Elabd, Linda Regan, Xavier Anton, Basil Ali Al-Natour, Yu Hsiang Hsieh, James Scheulen, Sarah A Stewart de Ramirez

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9–13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

Original languageEnglish (US)
Pages (from-to)385-395
Number of pages11
JournalInternal and Emergency Medicine
Issue number3
StatePublished - Apr 1 2018


  • Clinical handoff
  • Emergency service, hospital
  • Inter-unit communication
  • Patient admission

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine


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