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Introduction: Handovers in the ED are a high risk area for breakdown in team communication, discontinuity of patients’ clinical course, and potential medical errors. This is especially true for morning handovers at our center, when one single overnight MD working with limited resources hands over the entire ED to an oncoming day team of MDs and allied health professionals. We describe a quality improvement (QI) project to implement an inter-professional team approach during handovers. Methods: This prospective QI project took place at an academic tertiary care centre with >160,000 ED visits/yr. An expert working group identified key components of the ideal morning handover, and developed an intervention consisting of standardizing the “location”, “participants”, and “time” components of our handover processes. A research assistant directly observed all 8am handovers for 2 weeks pre- and 2 weeks post-intervention. Outcomes include participant attendance; # of beside RN issues proactively brought forward; frequency of new allied health consults and/or involvement triggered; # of physician interruptions; and time metrics. We report descriptive statistics. Results: During the study period a total of 308 individual patient handovers were observed [Pre:162, Post:146]. Average duration of total handover each morning decreased from 24.9min to 16.3min (p=0.051). Frequency of attendance at handovers increased for various allied health professionals, including care facilitators [Pre:35.7%; Post:91.7%, p=0.005], social workers [Pre:7.1%; Post:66.7%, p=0.003], geriatrics EM (GEM) RNs [Pre:64.3%; Post:83.3%, p=0.391], pharmacists [Pre:0.0%; Post:58.3%, p=0.001], and physiotherapists [Pre:0.0%; Post:58.3%, p=0.001]. Number of specific beside RN issues proactively brought forward increased [Pre:0; Post:4, p=0.049], while the number of physician interruptions during handover decreased [Pre:20; Post:0, p<0.0001]. Frequency of new allied health consults and/or involvement triggered as a result of handover participation increased from 6.8% to 13.7% (p=0.057). Conclusion: Implementation of a standardized team approach to morning handovers in the ED led to significant improvements in inter-professional contributions to patient care plans and overall efficiency. Future planned phases will build on this QI initiative by standardizing specific content of ED handovers.
