1626 - Sustained Use of a Standardized Communication Protocol for Emergency Department-to-Rehab Handoffs to Improve Patient Safety

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JR

Jessica Rosenblum, BS

Medical Student
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Co-Author(s)

CC

Craig Carcuffe, DO, MBA

Chief Resident
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States
PP

Palak R. Patel, MD

Fellow, Brain Injury Medicine
Rutgers NJMS/Kessler
West Orange, New Jersey, United States
JU

Julie Uspal, MD, MHQS

Associate Professor of Clinical Emergency Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States
KW

Kimberly J. Waddell, PhD, MSCI

Assistant Professor of Physical Medicine and Rehabilitation
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Submitter(s)

JR

Jessica Rosenblum, BS

Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Objectives: Standardized provider-to-provider handoffs are critical for safe transitions of care, particularly for medically complex patients returning from the emergency department (ED) to inpatient rehabilitation facilities (IRFs). We established a protocol, embedded within the electronic health record (EHR), that significantly increased documented provider-to-provider handoffs. This sustainability study evaluated whether these improvements were maintained six months post-implementation.

Design: We conducted a single-site quality improvement project at a standalone academic IRF with two phases: a pilot study (September–December 2024) that established feasibility, and a sustainability evaluation (January–June 2025). Analysis presented here focuses on the sustainability phase. The intervention included: 1) a dedicated Epic Secure Chat group (“Return to Rehab”), 2) modification of the PM&R ED referral note to prompt secure chat use, 3) an educational tip sheet, and 4) monthly audit and feedback to stakeholders. The primary outcome was the proportion of eligible patients with completed provider-to-provider handoffs. The secondary outcome was time from IRF arrival to updated code status order. Fisher’s Exact and Mann–Whitney U tests were used where appropriate to assess statistical significance.

Results: During the sustainability period, 50 eligible patients were acutely transferred from the IRF to the ED and returned. Of these, 36 (72%) had documented provider-to-provider handoffs, compared to 20 of 23 (87%) during the pilot (p = 0.24). Median [IQR] time to updated code status was 72 [13.5–303.8] minutes, compared to 93 [46–319.5] minutes in the pilot (p = 0.90).

Conclusions: Six months after implementation, the standardized ED-to-IRF handoff process demonstrated sustained adoption, with stable or slightly improved timeliness of code status updates. Although handoff completion rates decreased slightly, the change was not statistically significant, supporting durability of the intervention. Integration of EHR-based tools and ongoing interdisciplinary engagement highlight the scalability of this approach as a low-cost intervention to improve patient safety during rehabilitation transitions.