Data from: Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community based hospital to improve the safety of emergency room patient handovers

Objectives: Ensure early identification and timely management of patient
deterioration as essential components of safe effective healthcare.
Prompted by analyses of incident reports and deterioration events, a
multi-component organizational rescue from danger system was redesigned to
decrease unexpected in-patient deterioration. Design: Quality improvement
before-after unblinded trial Setting: 430 bed Canadian community teaching
hospital Participants: All admitted adult medical-surgical patients in a
before-after 12-month interventional study Intervention: Locally validated
checklist (Modified Early Warning Score-MEWS + urinary catheter in-situ +
nurse concern) with an intentional pause and explicit management options
was deployed as a modification of an existing ward transfer of
accountability fax report in the ED Results: Following deployment of
ER-STOP, the risk of an unexpected CCRT (Critical Care Response Team)
response within 24 hours of admission from ED to adult medical and
surgical wards was significantly decreased (OR: 4.1, 95% CI: 2.17 – 7.77).
Mean (+SD) ED wait-times (5.66+1.54 vs. 5.74+1.04 hours, p=0.30), ICU
admission rate (3.84%, n=233 vs. 4.61%, n= 278, p=0.06) and cardiac care
unit admission rate (9.51%, n =577 vs. 9.60%, n=579, p=0.198) were
unchanged. Conclusions: ER-STOP improvement was out of proportion to the
predictive value of the checklist component suggesting that effectiveness
of this low cost sustainable tool was related to increased situational
awareness, empowering a culture of patient safety and repurposing of an
adjacent ED medical short stay unit use. Local adaptation within existing
processes is essential to successful safety outcomes