Improving interunit transitions of care between emergency physicians and hospital medicine physicians: A conceptual approach

Christopher Beach, Dickson S. Cheung, Julie Apker, Leora I. Horwitz, Eric E. Howell, Kevin J. O'Leary, Emily S. Patterson, Jeremiah D. Schuur, Robert Wears, Mark Williams

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care.

Original languageEnglish
Pages (from-to)1188-1195
Number of pages8
JournalAcademic Emergency Medicine
Issue number10
StatePublished - Oct 2012


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