Improving Verbal Handoff for Patients Admitted From the Pediatric Emergency Department to Medical Inpatient Services: A Trainee-Led Quality Improvement Intervention.

OBJECTIVE: Transitions of care are a well-identified source of adverse events. At our academic tertiary children's hospital, no standardized verbal handoff is used in the emergency department with a lack of education provided to clinicians on handoff. We aimed to increase the percent of handoffs from the pediatric emergency department to inpatient medical services including 7 critical elements and increase clinician score of individual handoffs and overall clinician satisfaction with handoff key components. METHODS: Study occurred from Fall 2017 through Winter 2019. After collecting baseline data, a modified I-PASS tool was visually integrated into work areas. Tool education was performed by brief lecture, with iterative education occurring cyclically. Handoff assessment and clinician satisfaction surveys were then recollected. Outcome measures included clinician scores of individual handoffs and overall satisfaction with handoff. Process measure was percent handoffs including 7 critical elements. Balancing measure was handoff length in minutes. RESULTS: Clinician satisfaction scores improved from baseline (response rate, 38%) to postintervention (response rate, 30%) in efficiency (57%-69%), detail (57%-66%), and safety (55%-64%). Clinician scores of individual handoffs improved from 66% rating very good or excellent at baseline to 77% postintervention. Handoff time did not increase. Percent handoffs with all 7 critical elements did not show improvement. CONCLUSIONS: Trainee-led implementation of handoff standardization increased clinician satisfaction and clinician score of individual handoffs without compromising handoff length. Although feasibility can be a challenge, trainee-led quality improvement is meaningful and should be promoted and valued in graduate medical education, despite limitations.

Circumferential Partial-Thickness Burn Caused by Mobile Telephone Charger: A Case Report.

Many children and adolescents have access to portable electronic devices. Although not always the case, these devices are often charged at nighttime, especially while being used in bed. There are increasing media reports of electric current injury from the portable electronic devices' charging cables, particularly with equipment that is available for lower cost from generic manufacturers. A 19-year-old woman presented to the pediatric emergency department after a burn from her generic iPhone charger. She was lying in bed wearing a chain necklace, with the charger underneath her pillow and plugged into an electrical outlet, when she felt a sudden burning sensation and severe pain around her neck. She was found to have a circumferential partial-thickness burn. She underwent computed tomographic angiogram, whose result was unremarkable. The wound was debrided, and she was then discharged home. She likely sustained an electrical injury from the charger as it came in contact with her necklace, causing a burn. Several companies have investigated the difference in quality and safety of generic versus Apple-brand chargers and have found that the majority of the generic chargers fail basic safety testing, making them a higher risk for electrical injury. As a result of this case, patients and families should be educated about safe use of these devices, especially while they are charging.