Association Between Physician Handoffs and Major Adverse Outcomes in the Emergency Department: A Retrospective Cohort Study

IntroductionHandoffs between emergency physicians are common and suspected to contribute to communication errors, yet their association with clinical outcomes remains poorly documented.This study aimed to evaluate the association between physician handoffs and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay among patients hospitalized following an emergency department (ED) visit. MethodsA multicenter retrospective cohort study was conducted among all adult patients hospitalized following a visit to any of the five EDs of the CHU de Québec-Université Laval in Québec City, Canada, between April 2016 and March 2017.Data were extracted from the hospital administrative databases (MED-ECHO and SIURGE).Analyses were performed using generalized estimating equation (GEE) models with overlap weighting based on propensity scores, allowing adjustment for confounding and accounting for repeated visits.Subgroup analyses and multiple sensitivity analyses were conducted to assess the robustness of the findings. ResultsAmong the 21,136 ED visits resulting in hospitalization, 50.6% involved at least one handoff.No significant association was observed between handoffs and in-hospital mortality (adjusted risk ratio [aRR] = 1.11; 95% CI: 0.94-1.30),ICU admission (aRR = 1.06; 95% CI: 0.91-1.23),or hospital length of stay (adjusted geometric mean ratio [aGMR] = 1.01; 95% CI: 0.96-1.08).Results were consistent across all subgroup and sensitivity analyses. ConclusionHandoffs between emergency physicians were not associated with an increased risk of death, ICU admission, or prolonged length of stay.Improvement efforts should focus on other components of ED operations.