Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers
ObjectivesEnsure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpecte...
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| Veröffentlicht in: | BMJ open 2018-12, Vol.8 (12), p.e019553-e019553 |
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| creator | Norman, Savannah DeCicco, Frank Sampson, Jennifer Fraser, Ian M |
| description | ObjectivesEnsure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration.DesignQuality improvement before–after unblinded trial.Setting430-bed Canadian community teaching hospital.ParticipantsAll admitted adult medical–surgical patients in a before–after 12-month interventional study.InterventionLocally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED).ResultsFollowing deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95% CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04 hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged.ConclusionsER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes. |
| doi_str_mv | 10.1136/bmjopen-2017-019553 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6303585</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2156796900</sourcerecordid><originalsourceid>FETCH-LOGICAL-b472t-ae72b5322eb1764494fd04864d32901eb2f8748db88ee782ec5a7b6acc7beac43</originalsourceid><addsrcrecordid>eNqNkk1r3DAQhk1paUKaX1Aogl7Sg1NZX7Z7KISw_YBAQrI9C8keZ7VYliPJC_uj-h8r482S9lRdNIyeeecdNFn2vsCXRUHFZ223boQhJ7goc1zUnNNX2SnBjOUCc_76RXySnYewxekwnjjyNjuhKU0IrU6z3ysL_hGGZo_unbPoQXXg0dqrIcyB69CdigaGGNDF6j5_WN_effqCFHqaVG_iHhk7ercDmwhkBhNNoneAVExM46ydUm6faxWgRRsXRhNVj6J7rkNxAyiknkkq9YKjGT-bGZfWaKOGNsE-vMvedKoPcH64z7Jf31br6x_5ze33n9dXN7lmJYm5gpJoTgkBXZSCsZp1LWaVYC0lNS5Ak64qWdXqqgIoKwINV6UWqmlKDaph9Cz7uuiOk7bQNsmEV70cvbHK76VTRv79MpiNfHQ7KSimvOJJ4OIg4N3TBCFKa0IDfa8GcFOQpOClEAKzOqEf_0G3bvJDGm-mRFmLGuNE0YVqvAvBQ3c0U2A5b4Q8bIScN0IuG5GqPryc41jz_P8JuFyAVP1fin8A_8bGHg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2156796900</pqid></control><display><type>article</type><title>Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers</title><source>BMJ Open Access Journals</source><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central Open Access</source><source>PubMed Central</source><creator>Norman, Savannah ; DeCicco, Frank ; Sampson, Jennifer ; Fraser, Ian M</creator><creatorcontrib>Norman, Savannah ; DeCicco, Frank ; Sampson, Jennifer ; Fraser, Ian M</creatorcontrib><description>ObjectivesEnsure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration.DesignQuality improvement before–after unblinded trial.Setting430-bed Canadian community teaching hospital.ParticipantsAll admitted adult medical–surgical patients in a before–after 12-month interventional study.InterventionLocally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED).ResultsFollowing deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95% CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04 hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged.ConclusionsER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2017-019553</identifier><identifier>PMID: 30552238</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject><![CDATA[Adolescent ; Adult ; Aged ; Canada ; Checklist ; Critical care ; Diagnosis-Related Groups ; Emergency communications systems ; Emergency medical care ; Emergency Service, Hospital - organization & administration ; Female ; Health care ; Hospitals ; Hospitals, Community - organization & administration ; Hospitals, Teaching - organization & administration ; Humans ; Initiatives ; Intensive care ; Intervention ; Length of Stay - statistics & numerical data ; Male ; Medical Management ; Middle Aged ; Mortality ; Outcome and Process Assessment, Health Care ; Patient Admission ; Patient Handoff - organization & administration ; Patient Safety ; Patient Transfer - organization & administration ; Process controls ; Quality ; Quality control ; Quality improvement ; Quality Improvement - organization & administration ; Systematic review ; Vital signs ; Young Adult]]></subject><ispartof>BMJ open, 2018-12, Vol.8 (12), p.e019553-e019553</ispartof><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2018 Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b472t-ae72b5322eb1764494fd04864d32901eb2f8748db88ee782ec5a7b6acc7beac43</citedby><cites>FETCH-LOGICAL-b472t-ae72b5322eb1764494fd04864d32901eb2f8748db88ee782ec5a7b6acc7beac43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopen.bmj.com/content/8/12/e019553.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopen.bmj.com/content/8/12/e019553.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,27553,27554,27928,27929,53795,53797,77605,77636</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30552238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Norman, Savannah</creatorcontrib><creatorcontrib>DeCicco, Frank</creatorcontrib><creatorcontrib>Sampson, Jennifer</creatorcontrib><creatorcontrib>Fraser, Ian M</creatorcontrib><title>Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectivesEnsure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration.DesignQuality improvement before–after unblinded trial.Setting430-bed Canadian community teaching hospital.ParticipantsAll admitted adult medical–surgical patients in a before–after 12-month interventional study.InterventionLocally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED).ResultsFollowing deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95% CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04 hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged.ConclusionsER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Canada</subject><subject>Checklist</subject><subject>Critical care</subject><subject>Diagnosis-Related Groups</subject><subject>Emergency communications systems</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - organization & administration</subject><subject>Female</subject><subject>Health care</subject><subject>Hospitals</subject><subject>Hospitals, Community - organization & administration</subject><subject>Hospitals, Teaching - organization & administration</subject><subject>Humans</subject><subject>Initiatives</subject><subject>Intensive care</subject><subject>Intervention</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical Management</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Outcome and Process Assessment, Health Care</subject><subject>Patient Admission</subject><subject>Patient Handoff - organization & administration</subject><subject>Patient Safety</subject><subject>Patient Transfer - organization & administration</subject><subject>Process controls</subject><subject>Quality</subject><subject>Quality control</subject><subject>Quality improvement</subject><subject>Quality Improvement - organization & administration</subject><subject>Systematic review</subject><subject>Vital signs</subject><subject>Young Adult</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkk1r3DAQhk1paUKaX1Aogl7Sg1NZX7Z7KISw_YBAQrI9C8keZ7VYliPJC_uj-h8r482S9lRdNIyeeecdNFn2vsCXRUHFZ223boQhJ7goc1zUnNNX2SnBjOUCc_76RXySnYewxekwnjjyNjuhKU0IrU6z3ysL_hGGZo_unbPoQXXg0dqrIcyB69CdigaGGNDF6j5_WN_effqCFHqaVG_iHhk7ercDmwhkBhNNoneAVExM46ydUm6faxWgRRsXRhNVj6J7rkNxAyiknkkq9YKjGT-bGZfWaKOGNsE-vMvedKoPcH64z7Jf31br6x_5ze33n9dXN7lmJYm5gpJoTgkBXZSCsZp1LWaVYC0lNS5Ak64qWdXqqgIoKwINV6UWqmlKDaph9Cz7uuiOk7bQNsmEV70cvbHK76VTRv79MpiNfHQ7KSimvOJJ4OIg4N3TBCFKa0IDfa8GcFOQpOClEAKzOqEf_0G3bvJDGm-mRFmLGuNE0YVqvAvBQ3c0U2A5b4Q8bIScN0IuG5GqPryc41jz_P8JuFyAVP1fin8A_8bGHg</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Norman, Savannah</creator><creator>DeCicco, Frank</creator><creator>Sampson, Jennifer</creator><creator>Fraser, Ian M</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20181201</creationdate><title>Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers</title><author>Norman, Savannah ; DeCicco, Frank ; Sampson, Jennifer ; Fraser, Ian M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b472t-ae72b5322eb1764494fd04864d32901eb2f8748db88ee782ec5a7b6acc7beac43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Canada</topic><topic>Checklist</topic><topic>Critical care</topic><topic>Diagnosis-Related Groups</topic><topic>Emergency communications systems</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - organization & administration</topic><topic>Female</topic><topic>Health care</topic><topic>Hospitals</topic><topic>Hospitals, Community - organization & administration</topic><topic>Hospitals, Teaching - organization & administration</topic><topic>Humans</topic><topic>Initiatives</topic><topic>Intensive care</topic><topic>Intervention</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical Management</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Outcome and Process Assessment, Health Care</topic><topic>Patient Admission</topic><topic>Patient Handoff - organization & administration</topic><topic>Patient Safety</topic><topic>Patient Transfer - organization & administration</topic><topic>Process controls</topic><topic>Quality</topic><topic>Quality control</topic><topic>Quality improvement</topic><topic>Quality Improvement - organization & administration</topic><topic>Systematic review</topic><topic>Vital signs</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Norman, Savannah</creatorcontrib><creatorcontrib>DeCicco, Frank</creatorcontrib><creatorcontrib>Sampson, Jennifer</creatorcontrib><creatorcontrib>Fraser, Ian M</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Norman, Savannah</au><au>DeCicco, Frank</au><au>Sampson, Jennifer</au><au>Fraser, Ian M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>8</volume><issue>12</issue><spage>e019553</spage><epage>e019553</epage><pages>e019553-e019553</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectivesEnsure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration.DesignQuality improvement before–after unblinded trial.Setting430-bed Canadian community teaching hospital.ParticipantsAll admitted adult medical–surgical patients in a before–after 12-month interventional study.InterventionLocally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED).ResultsFollowing deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95% CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04 hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged.ConclusionsER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>30552238</pmid><doi>10.1136/bmjopen-2017-019553</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Canada Checklist Critical care Diagnosis-Related Groups Emergency communications systems Emergency medical care Emergency Service, Hospital - organization & administration Female Health care Hospitals Hospitals, Community - organization & administration Hospitals, Teaching - organization & administration Humans Initiatives Intensive care Intervention Length of Stay - statistics & numerical data Male Medical Management Middle Aged Mortality Outcome and Process Assessment, Health Care Patient Admission Patient Handoff - organization & administration Patient Safety Patient Transfer - organization & administration Process controls Quality Quality control Quality improvement Quality Improvement - organization & administration Systematic review Vital signs Young Adult |
| title | Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers |
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