Table 3.

EM-IM transition of care algorithm “PREP-4Cs.”

PREP-4Cs

Step 1. Preparation Immediate access to patient information, assessment, access to images, labs and medical record. Time commitment (2–5min) Space with minimal interruption

Step 2. Contact Sender and receiver identify themselves, including name and service “Face to face or voice to voice” to share real time information

Step 3. Communicate patient information Structured sign-out format for each institution Recommended as feasible mnemonics (alphabetical order) for EM-IM transition, cited from Riesenberg table14: HANDOFFS (Hospital location, Allergies, Name, DNR, Ongoing problem, Fact about hospitalization, Follow up, Scenarios) I PASS (Introduction, Patient name, Assessment, Situation, Safety concerns) SBAR (Situation, Background, Assessment, Recommendation) SBARR (Situation, Background, Assessment, Recommendation, Read back) SHARQ (Situation, History, Assessment, Recommendation, Questions) SIGNOUT (Sick, Identifying data, General hospital course, New events, Overall health status, Upcoming possibilities, Tasks) SOAP (Subjective, Objective, Assessment, Plan) Identification of high-risk patient: if high risk, explain the following: Why they are high risk How they may decompensate Planning for continued care Frequency of reassessment Code status or POLST

Step 4. Closing the loop Invitation for asking questions Discuss pending tests, treatment and delegate clear delineation of responsibility on follow ups Receiver verification of information

Step 5. Conclusion Conclusion Documentation of the transition of care Documentation of plan Open invitation for re-contact and discussion if a future need arises