Turn that frown upside down: Implementation of a visual cue improves communication during emergency department to inpatient hand-offs

Research output: Contribution to journalArticlepeer-review


When a patient is admitted to the hospital from the emergency department (ED), the ED clinician passes on relevant clinical information to the admitting team to transition care, a process known as patient hand-off and commonly referred to as â € calling report'. This information exchange between clinical teams is not only important for care continuity but also signifies a transition of care. However, there are unique challenges in this hand-off process given the unpredictability of the busy ED environment, ED boarding and discontinuity in physician, nursing and transportation workflows. These challenges create the potential for gaps in communication and can create patient safety concerns, particularly if a patient is transported to an inpatient bed before hand-off takes place. We set out to determine whether introducing a visual cue on the electronic health record (EHR) ED trackboard to communicate that report had been given would improve hand-off compliance. We sought to improve the utility of the visual cue and compliance of calling report prior to patient transport through a series of several Plan Do Study Act (PDSA) cycles. Baseline compliance using the â € Report Called' button prior to implementation of our visual intervention was 9.8%. With staff education alone, compliance rose to 41.3%. However, with an easily recognisable visual cue highlighted on the trackboard and an improved workflow compliance immediately rose to >97% and has been sustained for 84 months. Additionally, we have had zero reported incidents of patients being transported to a hospital bed before physician report was called since implementation. Our study demonstrates that simple visual cues and incorporation of a user-friendly process in the workflow can improve compliance with ensuring report is called prior to patient transfer from the ED. This may have a positive impact on physician communication and patient safety during the admission process.

Original languageEnglish (US)
Article numbere002078
JournalBMJ Open Quality
Issue number4
StatePublished - Dec 21 2022


  • Continuous quality improvement
  • Electronic Health Records
  • Patient Handoff
  • Quality improvement

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Turn that frown upside down: Implementation of a visual cue improves communication during emergency department to inpatient hand-offs'. Together they form a unique fingerprint.

Cite this