Introduction

We aimed to assess the current scope of handoff education and practice among resident physicians in academic centers, and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED) to an inpatient setting.

Methods

This was a cross-sectional survey targeted at emergency medicine residency programs in the United States (US). The Web-based survey consisted of multiple choice, completion, and Likert scale items and was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff.

Results

121 of 172 allopathic and osteopathic programs responded to the survey, for an overall response rate of 70.3%. Our survey showed that most EM programs in the US have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system over seventy percent of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess handoff proficiency of trainees.  Handoffs most commonly take place over the phone, though respondents disagreed about the ideal place for a handoff to occur with nearly equivalent responses between programs favoring the bedside, over the phone, or face to face at a computer station. Approximately 2/3 of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and review of the literature, we developed a five-step algorithm for the transition of care from the ED to an inpatient setting.

Conclusion

Social media (SM) is a form of electronic communication through which users create online communities and interactive platforms to exchange information, ideas, messages, podcasts, videos, and other user-generated content. Emergency medicine (EM) has embraced the healthcare applications of SM at a rapid pace and continues to explore the potential benefit for education. Free Open Access Meducation has emerged from the ever-expanding collection of SM interactions and now represents a virtual platform for sharing educational media. This guidance document constitutes an expert consensus opinion for best practices in the use of SM in EM residency education. The goals are the following: 1) Recommend adoption of SM as a valuable graduate medical education (GME) tool, 2) Provide advocacy and support for SM as a GME tool, and 3) Recommend best practices of educational deliverables using SM. These guidelines are intended for EM educators and residency programs for the development and use of a program-specific SM presence for residency education, taking into account appropriate SM stewardship that adheres to institution-specific guidelines, content management, Accreditation Council for GME milestone requirements, and integration of SM in EM residency curriculum to enhance the learner’s experience. Additionally, potential obstacles to the uptake of SM as an educational modality are discussed with proposed solutions.