Introduction A physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes.

Methods We included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Québec-Université Laval during fiscal year 2016-17. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted propensity score based analysis accounting for patient and hospital clusters and adjusting for demographics, multiple disease severity indicators and ED processes indicators, including crowding.

Results 21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In propensity score analysis (OR handoff/no handoff [CI95%] or GMR[Cl95%]), handoff status was not associated with mortality (1.08[0.93,1.26]), ICU admission (1.01[0.87,1.18]) or hospital length of stay (1.02[0.94-1.10]). Sensitivity and sub-group based analyses yielded no further information.

Conclusion Emergency physicians’ handoffs were not associated with an increase in risk of severe in-hospital adverse events. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity.

What is already known on this subject Handoffs are widely believed to affect patient outcomes in the ED, although data remains scarce.

What did this study ask What is the impact of handoffs between emergency physicians on patient outcomes

What this study adds Handed off patients do not seem to do worse than non handed off patients concerning majors outcomes (mortality, ICU admission, LOS).

Why does it matter to clinicians?In the ED, handoffs may not represent a risk to patient outcomes. QI efforts may be better invested in other care inefficiencies.

The authors have declared no competing interest.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This project was approved by the Comité d,éthique de la recherche du CHU de Québec-Université Laval. ID: 2018-3848

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Contributorship AM, SB and LM provided contribution to the design, conception, analyses and interpretation of the data. MM provided contribution to the acquisition of the data. DS provided contribution to the analyses and interpretation of the data. AM drafted the initial manuscript. All authors reviewed the manuscript for its intellectual content and approved the final version.

Funding There are no funders to report for this submission

Competing interests No conflicts of interests to report for any of the contributing authors.

Data Sharing/Data availability All necessary data is reported in the main document or as an Annex.

Ethics Approval Statements This project was approved by the Comité d’éthique de la recherche et de la Direction des services professionnels et du comité d’éthique du CHU de Québec-Université Laval, ID: 2018-3848

All data produced in the present study are available upon reasonable request to the authors