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SOUND: A Structured Handoff Tool Improves Patient Handoffs in a Pediatric Emergency Department

Gopwani, Priya R. MD; Brown, Kathleen M. MD; Quinn, Michael J. MD; Dorosz, Emily J. BSN, RN; Chamberlain, James M. MD

doi: 10.1097/PEC.0000000000000347
Original Articles

Introduction Handoff communication is an important contributor to safety and quality in the emergency department (ED). Breakdowns in this process may lead to unsafe conditions or adverse events. The purpose of this study was to test the hypothesis that the quality of patient handoffs in the pediatric ED would improve after implementation of a structured handoff method.

Methods In this prospective, observational study, we evaluated the implementation of a structured handoff tool, SOUND, which we developed to standardize the format of handoffs. The tool contains 5 components as follows: Synthesis, Objective Data, Upcoming Tasks, Nursing Input, and Double Check. SOUND was implemented through an online module and provider education. Handoffs were observed before and after implementation of SOUND. Statistical process control was used to measure the effects of the intervention. A successful handoff was defined as one in which 4 of the 5 components were included. As a balancing measure, we calculated mean time per handoff.

Results We observed 638 handoffs. The implementation of SOUND significantly increased the percentage of successful handoffs. Statistical process control demonstrated continued improvement over time. This improvement was associated with a modest increase in the mean time per patient discussed (52.9 vs 73.0 seconds, P < 0.01).

Conclusions It is feasible to standardize patient handoffs in the pediatric ED. The implementation of SOUND improved completeness of handoffs with only a modest increase in the mean time spent discussing each patient. Future study is required to determine if SOUND will prove effective in other ED settings.

From the Division of Emergency Medicine, Children’s National Medical Center, Washington, DC.

Disclosure: The authors declare no conflict of interest.

Reprints: Priya R. Gopwani, MD, Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Ave, Box 62, Chicago IL 60611-2991 (e-mail:

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