- The Enterprise
- The Recorder
After being rushed to an emergency room, patients may think they have a better chance of surviving whatever ails them, but a simple mistake could mean the difference between treatment and tragedy.
According to Dr. Drew Fuller, assistant director of the emergency department at Calvert Memorial Hospital in Prince Frederick, sometimes things can be overlooked when one doctor leaves the floor and another begins rounds in what is called a hand-off.
With the help of Fuller and Emergency Medicine Associates, the largest provider of emergency services in the region, safer sign-out has been developed to prevent mishaps in the emergency room.
It is EMA’s “flagship safety tool,” Fuller said. CMH is one of the first hospitals in the region to use the safety tool.
“The best hand-offs [when one doctor leaves and another replaces him or her] have inherent risks,” Fuller said regarding ER practices prior to safer sign-out.
Developed 10 months ago, the program, which has been used at CMH for the past nine months, is now getting national recognition, according to Fuller.
“Hospitals are watching one another to look for best practices,” said Dr. Jeff Schnabel, chairman of the ER at CMH.
Fuller will give a presentation this weekend about safer sign-out at the ninth annual Maryland Patient Safety Conference in Baltimore.
“Emergency medicine has struggled with how to [standardize hand-offs],” Fuller said.
He hopes the conference and the recent endorsement of the American College of Emergency Physicians will help make safer sign-out a national program, Fuller said.
“It will start a national conversation” about safer ER practices, he said.
The safer sign-out program, which is currently being used by 12 hospitals in Maryland, Virginia and Washington, D.C., was developed after some hospital doctors saw a need.
“We reached out to doctors at EMA and surveyed them,” Fuller said.
According to Schnabel, EMA looked at ways other industries used checklists to carry out safety checks, including the airline and surgery industries.
“We think there are elements [of safer sign-out] the nursing industry could use,” Schnabel said.
The 12 hospitals — CMH, Carroll Hospital Center, Civista Medical Center, Washington Adventist Hospital, Montgomery General Hospital, Sibley Memorial Hospital, Inova Alexandria Hospital, Prince William Hospital, Reston Hospital Center, Virginia Hospital Center, Heathcote Health Center and Jefferson Memorial Hospital — have a five-step hand-off process they must complete with the safer sign-out program.
According to documents obtained from Fuller, the doctor leaving must record with a designated sign-out form, then the two doctors (outgoing and incoming) must review the sign-out form and computer data together and do a round together, visiting all the patients. They then relay the information to the team, including nurses, and the incoming doctor gives feedback using the outgoing doctor’s mailbox to inform him or her of the patients’ current status.
“It is a patient-centered, team-based approach,” Fuller said.
So far, the doctors at CMH and the other participating hospitals have agreed the safer sign-out program is helping transitions in the emergency room, not hindering them, Fuller said.
“I had one doctor say, ‘I sleep better at night [because of safer sign-out],’” Fuller said. “It is easier to do [the safer sign-out initiative] than you think.”
Patients like having both doctors see them at the same time, CMH spokeswoman Kasia Sweeney said.
“It is also having a positive input on patients,” she said.
The safer sign-out is currently being used in the ER; however, it may be implemented in other departments at CMH in the future, Schnabel said.
“We have a very proactive safety leadership at Calvert,” he said.
According to Sweeney, CMH has a good record of patient safety.
“At Calvert, patient safety is a top priority,” she said.