Research Activities, August 2013
Chart biopsy may improve emergency department handoffs when patients are admitted to the hospital
Patient Safety and Quality
A new practice, the chart biopsy, in which clinicians review a patient’s electronic health record, may improve emergency department (ED) handoffs when patients are admitted to the hospital from the ED. The study authors found that the prehandoff chart biopsy aided clinicians in the general medicine service in three ways: getting an overview of the patient being admitted from the ED; preparing for handoff and subsequent care; and defending against potential biases (e.g., a particular diagnosis becoming established by its use in the ED, without sufficient evidence). In some cases, the prehandoff chart biopsy avoided unnecessary admissions or inappropriate placement of patients.
The researchers used data from the University of Michigan Health System, including 48 semistructured interviews, 349 hours of observations (146 hours in the ED, 108 hours on the hospitalist service, and 95 hours on the general medicine residency service). This involved a researcher shadowing 46 physicians, talking with many others, and recording 48 telephone handoff conversations between ED physicians and general medicine hospitalists and residents. The study was funded in part by AHRQ (HS18758).
More details are in "Chart biopsy: an emerging medical practice enabled by electronic medical records and its impacts on emergency department—inpatient admissions handoffs," by Brian Hilligoss, Ph.D., M.S.I.S., and Kai Zheng, Ph.D., in the March 2013 Journal of the American Medical Informatics Association 20(2), pp. 260-267.