343 - Randomized Controlled Trial Assessing the Utility Of Video Physical Exam During ED to Inpatient Handoff for Patients With Bronchiolitis Admitted on Heated High Flow Nasal Cannula

Poster Number: 343
Publication Number: 343.204

Kayleigh W. McBride, University of Texas Southwestern Medical School, Dallas, TX, United States; Jo-ann Nesiama, University of Texas Southwestern Medical School, Coppell, TX, United States; Joan S. Reisch, University of Texas Southwestern Medical School, Dallas, TX, United States; Courtney Solomon, University of Texas Southwestern Medical School, Dallas, TX, United States; Mohamed Badawy, University of Texas Southwestern Medical School, Dallas, TX, United States

Background:
Bronchiolitis is a leading cause of hospital admissions. Heated high flow nasal cannula (HHFNC) use, is common for children with bronchiolitis in respiratory distress requiring admissions. Verbal handoff between the emergency department (ED) and inpatient (IP) teams may be subjective and challenging for the IP clinician to ascertain the suitability for floor versus critical care admission. Virtual technology has expanded since Covid-19 but has not been evaluated for handoff between ED and IP.

Objective:
Our primary aim is to determine if the addition of a video physical exam at the time of ED to IP handoff shortens the time between ED handoff initiation and acceptance or refusal to the general IP service. Our secondary aim is to assess whether the use of the video improves satisfaction among ED and IP clinicians.

Design/Methods:
We conducted a randomized controlled trial between November 2020 and August 2021 at a  children’s ED. Patients with bronchiolitis requiring HHFNC and admission to the general IP service were randomized to verbal handoff or video exam handoff. Videos were standardized using Epic software (Haiku). ED clinicians recorded various time points during handoff to the nearest minute. Both ED and IP clinicians completed satisfaction surveys using a 5-point Likert scale. A two-sample t-test was performed to compare duration of time between handoff initiation and either acceptance or refusal of admission and to compare satisfaction scores between ED and IP clinicians.

Results:
103 children were enrolled with 50 (49%) assigned to verbal handoff and 53 (51%) assigned to video exam handoff. There was not a significant difference in duration of time between initiation of ED handoff to IP acceptance or refusal of admission: the verbal group (Mean = 9.18, SD = 11.86) and video exam group (Mean = 10.55, SD = 11.82); p = .559. Satisfaction survey response rate was 95% for ED clinicians and 75% for IP clinicians. There was no significant difference in clinician satisfaction between the two groups (p = .449). However, most comments from IP clinicians completing the survey positively regarded the use of video exam during handoff.
Conclusion(s):
The addition of a video physical exam neither shortened nor prolonged duration of time from ED handoff initiation to patients’ acceptance or refusal by the admitting IP service. Satisfaction scores were comparable among the two groups. This is the first study to evaluate virtual technology in handoff between ED and IP clinicians. Future studies may be considered as electronic health records video technologies become more widely available.

Kayleigh W McBride CVKayleigh W McBride CV Updated Nov 2021.pdf