SHM Converge Scientific Abstract ePoster Gallery-Closing the Loop: Improving Outpatient to Inpatient Direct Admission Handoffs

Pdf Summary

This project aimed to improve outpatient-to-inpatient handoffs for direct admissions to medicine services, a process that can reduce emergency department volume but also creates risks from delayed evaluation, poor communication, and unsafe transitions of care.<br /><br />To assess the problem, the team surveyed internal medicine residents and hospitalist physicians about direct admission communication. Of 188 invited clinicians, 45 responded (24%). Among respondents, dissatisfaction was high: 69% were unsatisfied or very unsatisfied with the current direct admission process and the quality of handoff information. Sixty-two percent were unsatisfied with their ability to reach the outpatient provider, and only 56% reported receiving a verbal handoff. More than half (51%) reported experiencing a near miss, medical error, or unsafe situation related to the direct admission process. Free-text responses highlighted unstable vital signs on arrival, inadequate handoff details, delayed treatment, and late notification of patient arrival as key safety concerns.<br /><br />To address these gaps, the team implemented an Epic-based intervention: a SmartText note template prompting ambulatory clinicians to enter key handoff information, and a SmartSet/ambulatory order set linking the handoff note to the bed request order. The tool was promoted through leadership outreach, faculty and section meetings, and a department-wide email.<br /><br />The intervention was feasible and sustainable. Use of the direct admission handoff note was tracked monthly, and the authors report that the process remained in use for seven months. The project suggests that standardized electronic templates and linked order sets can improve documentation and consistency of handoffs for direct admissions. Future work will focus on section-level adoption rates, targeted outreach, and user feedback to further increase uptake and ease of use.

Asset Subtitle

Khanh T. Nguyen

Meta Tag

Author List Catherine Waymel, Khanh T. Nguyen, Micah T. Prochaska, Mikail Siddiki, Misha C. Tran, Rukmini Roy, Seth Scheetz

Category Research

Concept Direct Admission

Concept Patient Safety Risk

Concept Outpatient-to-Inpatient Handoff

Concept Electronic Health Record

Concept Handoff Tool

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Khanh T. Nguyen

Track Transitions of Care

Keywords

direct admission

handoff communication

outpatient to inpatient

medicine services

patient safety

Epic SmartText

SmartSet order set

hospitalist physicians

internal medicine residents

care transitions

Direct Admission

Patient Safety Risk

Outpatient-to-Inpatient Handoff

Electronic Health Record

Handoff Tool