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Leeper WR, James N. Trauma Bay Evaluation and Resuscitative Decision-Making. Surg Clin North Am 2024; 104:293-309. [PMID: 38453303 DOI: 10.1016/j.suc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The reader of this article will now have the ability to reflect on all aspects of high-quality trauma bay care, from resuscitation to diagnosis and leadership to debriefing. Although there is no replacement for experience, both clinically and in a simulation environment, trauma clinicians are encouraged to make use of this article both as a primer at the beginning of a trauma rotation and a reference text to revisit after difficult cases in the trauma bay. Also, periods of reflection seem appropriate in the busy but, of course, rewarding career in trauma care.
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Affiliation(s)
- William Robert Leeper
- Department of Surgery, Western University, Victoria Campus, London Health Sciences Center, Room E2-215, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Division of Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Nicholas James
- London Health Sciences Center, Victoria Campus, Room E2-214, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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2
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Bagot KL, Bladin CF, Vu M, Bernard S, Smith K, Hocking G, Coupland T, Hutton D, Badcock D, Budge M, Nadurata V, Pearce W, Hall H, Kelly B, Spencer A, Chapman P, Oqueli E, Sahathevan R, Kraemer T, Hair C, Dion S, McGuinness C, Cadilhac DA. Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care. J Eval Clin Pract 2024; 30:184-198. [PMID: 37721181 DOI: 10.1111/jep.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
RATIONALE Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context. AIMS To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology. METHODS We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders). RESULTS Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times. CONCLUSION Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.
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Affiliation(s)
- Kathleen L Bagot
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Chris F Bladin
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Michelle Vu
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Bernard
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Silverchain Group, Melbourne, Victoria, Australia
| | | | | | - Debra Hutton
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | | | - Marc Budge
- Bendigo Health, Bendigo, Victoria, Australia
| | | | - Wayne Pearce
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Howard Hall
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ben Kelly
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Angie Spencer
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | | | - Ernesto Oqueli
- Grampians Health Ballarat, Ballarat, Victoria, Australia
- Department of Medicine, Deakin University, Burwood, Victoria, Australia
| | - Ramesh Sahathevan
- Grampians Health Ballarat, Ballarat, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Ballarat Clinical School, School of Medicine, Deakin University, Ballarat, Australia
| | - Thomas Kraemer
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Casey Hair
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Stub Dion
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Connor McGuinness
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Dominique A Cadilhac
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Hans FP, Krehl J, Kühn M, Fuchs MW, Weiser G, Busch HJ, Benning L. [Handover protocols in the emergency department]. Med Klin Intensivmed Notfmed 2024; 119:71-81. [PMID: 37989878 DOI: 10.1007/s00063-023-01079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 11/23/2023]
Abstract
Patient handovers are a vital juncture in the flow of medical information, and regardless of the mode of handover-oral, written, or combined-it often poses a risk of information loss. This could potentially jeopardize patient safety and influences subsequent treatment. The exchange of information in emergency care settings between paramedics and emergency personnel is particularly prone to errors due to situational specifics such as high ambient noise, the involvement of multiple disciplines, and the need for urgent decision-making in life-threatening situations. As handover training is not yet universally incorporated into education and ongoing training programs, there is a high degree of variability in how it is carried out in practice. However, strategies aimed at enhancing the handover process carry substantial potential for improving staff satisfaction, process quality, and possibly even having a positive prognostic impact.
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Affiliation(s)
- Felix Patricius Hans
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland.
| | - Julian Krehl
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
| | - Matthias Kühn
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
| | - Matthias Wilhelm Fuchs
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
| | - Gerda Weiser
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
| | - Hans-Jörg Busch
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
| | - Leo Benning
- Zentrum für Notfall und Rettungsmedizin, Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg, Deutschland
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Nagaraj MB, Lowe JE, Marinica AL, Fowler RL, Salazar GA, Dumas RP. Assessing North Texas Regional Trauma Handoffs: A Multicenter Mixed-Methods Needs Assessment. J Surg Res 2023; 291:124-132. [PMID: 37385010 DOI: 10.1016/j.jss.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Trauma video review of Emergency Medical Services (EMS) handoffs demonstrates frequent problems including interruptions and incomplete information transfer. This study aimed to perform a regional needs assessment of handoff perceptions and expectations to guide future standardization efforts. METHODS A multidisciplinary team of trauma providers through consensus building created an anonymous survey which was then distributed through the North Central Texas Trauma Regional Advisory Council and four regional level-1 trauma institutions. Qualitative data underwent content analysis; quantitative data are presented with descriptive statistics. RESULTS Survey responses (n = 249) were submitted by trauma nurses (38%), EMS (24%), emergency physicians (14%), and trauma physicians (13%). Median overall handoff quality was rated well (4, scale 1-5) despite some variability between hospitals (3, scale 1-5). The top five most important handoff details were the same for both stable and unstable patients: primary mechanism, blood pressure, heart rate, Glasgow Coma Scale, and location of injuries. While providers felt neutral about the data order, the vast majority supported immediate bed transfer and primary survey in unstable patients. The majority of receiving providers report interrupting handoff at least once (78%); and 66% of EMS clinicians found interruptions disruptive. Content analysis revealed top priority categories for improvement: environment, communication, information relayed, team dynamics, and flow of care. CONCLUSION Although our data demonstrated satisfaction and concordance with respect to the EMS handoff, 84% of EMS clinicians reported some to high amounts of variability across institutions. Gaps in the development of standardized handoffs identified include exposure, education, and enforcement of these protocols.
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Affiliation(s)
- Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jessica E Lowe
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander L Marinica
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Raymond L Fowler
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gilberto A Salazar
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan P Dumas
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Heuer C, Howard I, Stassen W. Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar. BMJ Open Qual 2023; 12:e002263. [PMID: 37963672 PMCID: PMC10649605 DOI: 10.1136/bmjoq-2023-002263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Adverse events (AEs) in helicopter emergency medical services (HEMS) remain poorly reported, despite the potential for harm to occur. The trigger tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their proximal causes (PCs) in Qatar HEMS. METHODS Using the Pittsburgh Adverse Event Tool to identify AEs in HEMS, we retrospectively analysed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for triggers, AEs and harm per 100 patient encounters, plotted measures on statistical process control charts, and conducted a multivariate analysis to report harm associations. RESULTS We identified 883 triggers in 536 patients, with a rate of 1.1 triggers per patient encounter, where 81.2% had documentation errors (n=436). An AE and harm rate of 27.7% and 3.5%, respectively, was realised. The leading PC was actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the intervention and medication triggers (n=16), where deviation from standard of care was common (37.9%; n=11). Age and diagnosis-adjusted odds were significant in the patient condition (6.50; 95% CI 1.71 to 24.67; p=0.01) and interventional (11.85; 95% CI 1.36 to 102.92; p=0.03) trigger groupings, while age and diagnosis had no effect on harm. CONCLUSION The TT methodology is a robust, reliable and valid means of AE detection in the HEMS domain. While an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and documentation errors should also be addressed in future research.
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Affiliation(s)
- Calvin Heuer
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Ian Howard
- Clinical Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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van Maarseveen OEC, Ham WHW, Leenen LPH. Future perspectives of higher standards for trauma teams' organization, support, and evaluation. Eur J Trauma Emerg Surg 2023; 49:1661-1664. [PMID: 36542110 PMCID: PMC10449656 DOI: 10.1007/s00068-022-02196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Cheetham A, Frey M, Harun N, Kerrey B, Riney L. A Video-Based Study of Emergency Medical Services Handoffs to a Pediatric Emergency Department. J Emerg Med 2023; 65:e101-e110. [PMID: 37365111 DOI: 10.1016/j.jemermed.2023.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Emergency medical services (EMS) to emergency department (ED) handoffs are important moments in patient care, but patient information is communicated inconsistently. OBJECTIVE The aim of this study was to describe the duration, completeness, and communication patterns of patient handoffs from EMS to pediatric ED clinicians. METHODS We conducted a video-based, prospective study in the resuscitation suite of an academic pediatric ED. All patients 25 years and younger transported via ground EMS from the scene were eligible. We completed a structured video review to assess frequency of transmission of handoff elements, handoff duration, and communication patterns. We compared outcomes between medical and trauma activations. RESULTS We included 156 of 164 eligible patient encounters from January to June 2022. Mean (SD) handoff duration was 76 (39) seconds. Chief symptom and mechanism of injury were included in 96% of handoffs. Most EMS clinicians communicated prehospital interventions (73%) and physical examination findings (85%). However, vital signs were reported for fewer than one-third of patients. EMS clinicians were more likely to communicate prehospital interventions and vital signs for medical compared with trauma activations (p < 0.05). Communication challenges between EMS clinicians and the ED were common; ED clinicians interrupted EMS or requested information already communicated by EMS in nearly one-half of handoffs. CONCLUSIONS EMS to pediatric ED handoffs take longer than recommended and frequently lack important patient information. ED clinicians engage in communication patterns that may hinder organized, efficient, and complete handoff. This study highlights the need for standardizing EMS handoff and ED clinician education regarding communication strategies to ensure active listening during EMS handoff.
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Affiliation(s)
- Alexandra Cheetham
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Mary Frey
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nusrat Harun
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Kerrey
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Lauren Riney
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio
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Müller F, Schröder D, Schäning J, Schmid S, Noack EM. Lost in translation? Information quality in pediatric pre-hospital medical emergencies with a language barrier in Germany. BMC Pediatr 2023; 23:312. [PMID: 37344777 DOI: 10.1186/s12887-023-04121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers. METHODS We conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS). RESULTS Data from 1,430 pediatric rescue missions were analyzed with 3.1% (n = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results. CONCLUSION Language barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies. TRIAL REGISTRATION This is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.
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Affiliation(s)
- Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany.
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
| | - Jennifer Schäning
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
| | - Sybille Schmid
- Fire Department, City of Braunschweig, Brunswick, DE, Germany
| | - Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
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Nagaraj MB, Lowe JE, Marinica AL, Morshedi BB, Isaacs SM, Miller BL, Chou AD, Cripps MW, Dumas RP. Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills. PREHOSP EMERG CARE 2023; 27:10-17. [PMID: 34731071 DOI: 10.1080/10903127.2021.2000684] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Handoffs by emergency medical services (EMS) personnel suffer from poor structure, inattention, and interruptions. The relationship between the quality of EMS communication and the non-technical performance of trauma teams remains unknown. METHODS We analyzed 3 months of trauma resuscitation videos (highest acuity activations or patients with an Injury Severity Score [ISS] of ≥15). Handoffs were scored using the mechanism-injury-signs-treatment (MIST) framework for completeness (0-20), efficiency (category jumps), interruptions, and timeliness. Trauma team non-technical performance was scored using the Trauma Non-Technical Skills (T-NOTECHS) scale (5-15). RESULTS We analyzed 99 videos. Handoffs lasted a median of 62 seconds [IQR: 43-74], scored 11 [10-13] for completeness, and had 2 [1-3] interruptions. Most interruptions were verbal (85.2%) and caused by the trauma team (64.9%). Most handoffs (92%) were efficient with 2 or fewer jumps. Patient transfer during handoff occurred in 53.5% of the videos; EMS providers giving handoff helped transfer in 69.8% of the Primary surveys began during handoff in 42.4% of the videos. Resuscitation teams who scored in the top-quartile on the T-NOTECHS (>11) had higher MIST scores than teams in lower quartiles (13 [11.25-14.75] vs. 11 [10-13]; p < .01). There were no significant differences in ISS, efficiency, timeliness, or interruptions between top- and lower-quartile groups. CONCLUSIONS There is a relationship between EMS MIST completeness and high performance of non-technical skill by trauma teams. Trauma video review (TVR) can help identify modifiable behaviors to improve EMS handoff and resuscitation efforts and therefore trauma team performance.
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Affiliation(s)
- Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica E Lowe
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander L Marinica
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon B Morshedi
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - S Marshal Isaacs
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brian L Miller
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew D Chou
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan P Dumas
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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R M, Pap R, Hardcastle TC. Variables required for the audit of quality completion of patient report forms by EMS—A scoping review. Afr J Emerg Med 2022; 12:438-444. [DOI: 10.1016/j.afjem.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/22/2022] [Accepted: 09/27/2022] [Indexed: 11/01/2022] Open
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Collopy K, Zimmerman L, Westmoreland AM, Powers WF. Prehospital Administration of Cefazolin in Trauma Patients. Air Med J 2022; 41:447-450. [PMID: 36153141 DOI: 10.1016/j.amj.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE A lack of research has become a barrier to the common use of prehospital antibiotics. The objective of this study is to further the limited research of prehospital antibiotics through evaluating the clinical impact, safety, and reliability of prehospital cefazolin administration in trauma patients. METHODS We completed a retrospective evaluation of adult trauma patients who were transported by a single air and ground critical care transport program between January 1, 2014, and June 30 2017. Two hundred eighty-two patients received prehospital cefazolin for deep wounds or open fractures before their arrival at a single level 2 trauma center during the study period. Patient demographics, mechanism of injury, injury type, infection rate, and identification of allergic reactions to cefazolin were also collected. RESULTS Of 278 patients in the final analysis, 35.3% (n = 98) were diagnosed with an open fracture and 58.6% (n = 163) had a deep tissue injury. Eighty-two percent of prehospital open fracture diagnoses were confirmed in the emergency department. The overall infection rate was 6%; 31.3% of patients received a second dose of cefazolin in the emergency department during the study period. No patients receiving prehospital cefazolin had allergic or anaphylactic reactions. The overadministration rate was 5% (n = 14). CONCLUSION Prehospital providers reliably identified open fractures, and prehospital cefazolin administration was not associated with anaphylactic reactions. This study population's infection rate of open fractures caused by traumatic injury was found to be 6%, and there was a low inappropriate administration rate.
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Affiliation(s)
- Kevin Collopy
- AirLink/VitaLink Critical Care Transport, Novant Health New Hanover Regional Medical Center, Wilmington, NC.
| | - Lisa Zimmerman
- Department of Pharmacy, Novant Health New Hanover Regional Medical Center, Wilmington, NC
| | | | - William F Powers
- AirLink/VitaLink Critical Care Transport, Novant Health New Hanover Regional Medical Center, Wilmington, NC; Department of Surgery, Novant Health New Hanover Regional Medical Center, Wilmington, NC
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Mckenzie RB, Pap R, Hardcastle T. Development of a checklist for auditing completion of patient report forms: A Delphi study. Afr J Emerg Med 2022; 12:191-198. [PMID: 35702138 PMCID: PMC9178481 DOI: 10.1016/j.afjem.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
Information loss during the handover from Emergency Care Providers to hospital staff is common and has a significant impact on patient care. Development of prehospital emergency care quality systems, such as checklists, has been limited in the African context Using a Delphi survey we identify relevant South African-specific elements to improve the validity and generalisability of a patient report form checklist.
Introduction Medical records are an integral part of patient care. Information loss during the handover from Emergency Care Providers to hospital staff is common and has a significant impact on patient care. Information loss can be prevented with medical documentation that is accurate, complete and contains the relevant information regarding patient management. Patient report Forms (PRF's) are used by Emergency Care Providers to record the details of their patient care and they form part of the patients’ medical records. Quality assuring of PRF's is required to determine if the required information has been recorded on the PRF. Checklists are one the means of quality assuring PRF, by comparing the points on the checklist to the content of the PRF. Methods An three-round Delphi survey was conducted with experts to determine the relevant information (data elements) required for the completion of a PRF including any additional South African – specific elements. Results Thirty-two experts participated in the Delphi survey, which identified 166 data elements for the check list and this was refined to a final 133 elements after collation by the researchers. A proposed checklist was developed. Discussion The Delphi process is a useful technique to develop a checklist. A checklist consisting of 133 total possible data elements to quality assure PRFs was designed. Further research regarding the use and reliability of the checklist is required.
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Affiliation(s)
- Robert Bruce Mckenzie
- Dept of Emergency Medical Care, Durban University of Technology, Durban, South Africa
| | - Robin Pap
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Timothy Hardcastle
- Dept of Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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Cooper BH. Exploring the factors that influence trauma team activation in emergency department staff. Emerg Nurse 2022; 30:e2133. [PMID: 35502574 DOI: 10.7748/en.2022.e2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/09/2022]
Abstract
Regional trauma networks enable the rapid and safe management and transfer of patients with traumatic injury between designated trauma units and one of 27 major trauma centres throughout the UK. Multispecialty trauma teams are available 24 hours a day, seven days a week, and are activated immediately upon receipt of a patient presenting with major trauma. With most serious trauma patients going direct to major trauma centres rather than a less specialised hospital-based trauma unit, it can be challenging for hospital-based trauma unit staff to gain experience and skill in this area, leading to potential inconsistencies in the process of activating the trauma team. The aim of this service evaluation was to identify factors influencing the decision to activate the trauma team in emergency department (ED) staff working within a 700-bed trauma unit. A questionnaire was sent to 107 staff and 70 completed it, a response rate of 65%. Results indicated that shortfalls in trauma-specific training, lack of clinical experience, undefined roles and responsibilities, department culture, ambulance handover, knowledge of clinical guidelines and previous experience of trauma team activation all affected the decision to activate the trauma team. Trauma-specific training and the support of senior staff could enhance confidence and appropriate trauma team activation rates.
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Maris M, Berben SAA, Verhoef W, van Grunsven P, Tan ECTH. The quality of pre-announcement communication and the accuracy of estimated arrival time in critically ill patients, a prospective observational study. BMC Emerg Med 2022; 22:44. [PMID: 35305570 PMCID: PMC8933928 DOI: 10.1186/s12873-022-00601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Efficient communication between (helicopter) emergency medical services ((H)EMS) and healthcare professionals in the emergency department (ED) is essential to facilitate appropriate team mobilization and preparation for critically ill patients. A correct estimated time of arrival (ETA) is crucial for patient safety and time-management since all team members have to be present, but needless waiting must be avoided. The aim of this study is to investigate the quality of the pre-announcement and the accuracy of the ETA.
Methods
A prospective observational study was conducted in potentially critically ill/injured patients transported to the ED of a Level I trauma center by the (H)EMS. Research assistants observed time slots prior to arrival at the ED and during the initial assessment, using a stopwatch and an observation form. Information on the pre-announcement (including mechanisms of injury, vital signs, and the ETA) is also collected.
Results
One hundred and ninety-three critically ill/injured patients were included. Information in the pre-announcement was often incomplete; in particular vital signs (86%). Forty percent of the announced critically ill patients were non-critical at arrival in the ED. The observed time of arrival (OTA) for 66% of the patients was later than the provided ETA (median 5:15 min) and 19% of the patients arrived sooner (3:10 min). Team completeness prior to the arrival of the patient was achieved for 66% of the patients.
Conclusions
The quality of the pre-announcement is moderate, sometimes lacking essential information on vital signs. Forty percent of the critically ill patients turned out to be non-critical at the ED. Furthermore, the ETA was regularly inaccurate and team completeness was insufficient. However, none of the above was correlated to the rate of complications, mortality, LOS, ward of admission or discharge location.
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Butler J, Wright E, Longbottom L, Whitelaw AS, Thomson K, Gordon MWG, Lowe DJ. Usability of novel major TraumaApp for digital data collection. BMC Emerg Med 2022; 22:39. [PMID: 35279070 PMCID: PMC8917623 DOI: 10.1186/s12873-022-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Delivery of major trauma care is complex and often fast paced. Clear and comprehensive documentation is paramount to support effective communication during complex clinical care episodes, and to allow collection of data for audit, research and continuous improvement. Clinical events are typically recorded on paper-based records that are developed for individual centres or systems. As one of the priorities laid out by the Scottish Trauma Network project was to develop an electronic data collection system, the TraumaApp was created as a data collection tool for major trauma that could be adopted worldwide. Methods The study was performed as a service evaluation based at the Queen Elizabeth University Hospital Emergency Department. Fifty staff members were recruited in pairs and listened to five paired major trauma standby and handover recordings. Participants were randomised to input data to the TraumaApp and one into the existing paper proforma. The time taken to input data add into was measured, along with time for clarifications and any errors made. Those using the app completed a System Usability Score. Results No statistically significant difference was demonstrated between times taken for data entry for the digital and paper documentation, apart from the Case 5 Handover (p < 0.05). Case 1 showed a significantly higher time for clarifications and number of errors with digital data collection (p = 0.01 and p = 1.79E-05 respectively). There were no other differences between data for the app and the proforma. The mean System Usability score for this cohort was 75 out of 100, with a standard deviation of 17 (rounded to nearest integer). Conclusion Digital real-time recording of clinical events using a tool such as the TraumaApp is comparable to completion of paper proforma. The System Usability Score for the TraumaApp was above the internationally validated standard of acceptable usability. There was no evidence of improvement in use over time or familiarity, most likely due to the brevity of the assessments and the refined user interface. This would benefit from further research, exploring data completeness and a potential mixed methods approach to explore training requirements for use of the TraumaApp. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00578-9.
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Golling M, Behringer W, Schwarzkopf D. Assessing the quality of patient handovers between ambulance services and emergency department – development and validation of the emergency department human factors in handover tool. BMC Emerg Med 2022; 22:10. [PMID: 35045828 PMCID: PMC8772155 DOI: 10.1186/s12873-022-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient handover between prehospital care and the emergency department plays a key role in patient safety. Therefore, we aimed to create a validated tool for measuring quality of communication and interprofessional relations during handover in this specific setting.
Methods
Based on a theoretical framework a comprehensive item pool on information transfer and human factors in emergency department handovers was created and refined in a modified Delphi survey involving clinical experts. Based on a pre-test, items were again revised. The resulting Emergency Department Human Factors in Handover tool (ED-HFH) was validated in a field test at the emergency department of a German university hospital from July to December 2017. The ED-HFH was completed by emergency department and ambulance service staff participating in handovers and by an external observer. Description of item characteristics, exploratory factor analysis, analyses on internal consistency and interrater reliability by intraclass-correlation. Construct validity was analysed by correlation with an overall rating on quality of the handover.
Results
The draft of the ED-HFH contained 24 items, 90 of 102 eligible staff members participated in the field test completing 133 questionnaires on 38 observed handovers. Four items were deleted after analysis of item characteristics. Factor analysis supported a single factor explaining 39% of variance in the items. Therefore, a sum-score was calculated with a possible range between 14 and 70. The median value of the sum-score in the sample was 61.5, Cronbach’s α was 0.83, intraclass-correlation was 0.52, the correlation with the overall rating of hand-over quality was ρ = 0.83 (p ≤ 0.001).
Conclusions
The ED-HFH showed its feasibility, reliability and validity as a measure of quality of information transfer and human factors in handovers between ambulance services and the emergency department. It promises to be a useful tool for quality assurance and staff training.
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Woo M, Mishra P, Lin J, Kar S, Deas N, Linduff C, Niu S, Yang Y, McClendon J, Smith DH, Shelton SL, Gainey CE, Gerard WC, Smith MC, Griffin SF, Gimbel RW, Wang KC. Complete and Resilient Documentation for Operational Medical Environments Leveraging Mobile Hands-free Technology in a Systems Approach: Experimental Study. JMIR Mhealth Uhealth 2021; 9:e32301. [PMID: 34636729 PMCID: PMC8548972 DOI: 10.2196/32301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Prehospitalization documentation is a challenging task and prone to loss of information, as paramedics operate under disruptive environments requiring their constant attention to the patients. Objective The aim of this study is to develop a mobile platform for hands-free prehospitalization documentation to assist first responders in operational medical environments by aggregating all existing solutions for noise resiliency and domain adaptation. Methods The platform was built to extract meaningful medical information from the real-time audio streaming at the point of injury and transmit complete documentation to a field hospital prior to patient arrival. To this end, the state-of-the-art automatic speech recognition (ASR) solutions with the following modular improvements were thoroughly explored: noise-resilient ASR, multi-style training, customized lexicon, and speech enhancement. The development of the platform was strictly guided by qualitative research and simulation-based evaluation to address the relevant challenges through progressive improvements at every process step of the end-to-end solution. The primary performance metrics included medical word error rate (WER) in machine-transcribed text output and an F1 score calculated by comparing the autogenerated documentation to manual documentation by physicians. Results The total number of 15,139 individual words necessary for completing the documentation were identified from all conversations that occurred during the physician-supervised simulation drills. The baseline model presented a suboptimal performance with a WER of 69.85% and an F1 score of 0.611. The noise-resilient ASR, multi-style training, and customized lexicon improved the overall performance; the finalized platform achieved a medical WER of 33.3% and an F1 score of 0.81 when compared to manual documentation. The speech enhancement degraded performance with medical WER increased from 33.3% to 46.33% and the corresponding F1 score decreased from 0.81 to 0.78. All changes in performance were statistically significant (P<.001). Conclusions This study presented a fully functional mobile platform for hands-free prehospitalization documentation in operational medical environments and lessons learned from its implementation.
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Affiliation(s)
- MinJae Woo
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, GA, United States
| | - Prabodh Mishra
- Department of Electrical and Computing Engineering, Clemson University, Clemson, SC, United States
| | - Ju Lin
- Department of Electrical and Computing Engineering, Clemson University, Clemson, SC, United States
| | - Snigdhaswin Kar
- Department of Electrical and Computing Engineering, Clemson University, Clemson, SC, United States
| | - Nicholas Deas
- School of Computing, Clemson University, Clemson, SC, United States
| | - Caleb Linduff
- Department of Electrical and Computing Engineering, Clemson University, Clemson, SC, United States
| | - Sufeng Niu
- Linkedin Inc, Mountain View, CA, United States
| | | | - Jerome McClendon
- Department of Automotive Engineering, Clemson University, Clemson, SC, United States
| | - D Hudson Smith
- Watt Family Innovation Center, Clemson University, Clemson, SC, United States
| | - Stephen L Shelton
- Department of Emergency Medical Services, Prisma Health Richland Hospital, Columbia, SC, United States
| | - Christopher E Gainey
- Department of Emergency Medical Services, Prisma Health Richland Hospital, Columbia, SC, United States
| | - William C Gerard
- Department of Emergency Medical Services, Prisma Health Richland Hospital, Columbia, SC, United States
| | - Melissa C Smith
- Department of Electrical and Computing Engineering, Clemson University, Clemson, SC, United States
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Kuang-Ching Wang
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
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Massoth C, Meersch M. [Safer anesthesia and duty hour limits: are handovers of personnel allowed?]. Anaesthesist 2021; 70:439-448. [PMID: 33825936 DOI: 10.1007/s00101-021-00949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Restrictions of duty hours in medicine are an ambivalent matter with respect to patient safety. Continuity of treatment carries the risk of medical errors from declining performance capability and must be balanced against the risk of communication failure and information loss due to personnel changes. Complete intraoperative changes of anesthetists are frequently carried out in the clinical routine but possibly have the potential to negatively influence the postoperative morbidity and mortality. The relevance of anesthesiological care for the perioperative outcome also seems to vary depending on the specialist discipline involved. While standardized handover protocols seem to be only of limited effectiveness for the improvement of transfer of information, they are nevertheless a reasonable approach for optimization of interprofessional communication and reduction of treatment errors.
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Affiliation(s)
- Christina Massoth
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland
| | - Melanie Meersch
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland.
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Clinical handover from emergency medical services to the trauma team: A gap analysis. CAN J EMERG MED 2020; 22:S21-S29. [PMID: 33084560 DOI: 10.1017/cem.2019.438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES There has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be beneficial for trauma team performance. METHODS Data were prospectively collected over a nine-week period by a trained observer at a Canadian level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders and EMS according to a bidirectional Likert scale. RESULTS 79 formal verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Of all questions asked, 35% were questioning previously given information. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking. There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders. CONCLUSIONS We have identified the need to standardize handover due to poor information content, a lack of structure and active listening, information repetition, and discordant expectations between team members. These data will guide the development of a co-constructed framework integrating the perspectives of all team members.
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Novak LL, Simpson CL, Coco J, McNaughton CD, Ehrenfeld JM, Bloos SM, Fabbri D. Understanding the Information Needs and Context of Trauma Handoffs to Design Automated Sensing Clinical Documentation Technologies: Qualitative Mixed-Method Study of Military and Civilian Cases. J Med Internet Res 2020; 22:e17978. [PMID: 32975522 PMCID: PMC7547393 DOI: 10.2196/17978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/07/2020] [Accepted: 07/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current methods of communication between the point of injury and receiving medical facilities rely on verbal communication, supported by brief notes and the memory of the field medic. This communication can be made more complete and reliable with technologies that automatically document the actions of field medics. However, designing state-of-the-art technology for military field personnel and civilian first responders is challenging due to the barriers researchers face in accessing the environment and understanding situated actions and cognitive models employed in the field. OBJECTIVE To identify design insights for an automated sensing clinical documentation (ASCD) system, we sought to understand what information is transferred in trauma cases between prehospital and hospital personnel, and what contextual factors influence the collection, management, and handover of information in trauma cases, in both military and civilian cases. METHODS Using a multi-method approach including video review and focus groups, we developed an understanding of the information needs of trauma handoffs and the context of field documentation to inform the design of an automated sensing documentation system that uses wearables, cameras, and environmental sensors to passively infer clinical activity and automatically produce documentation. RESULTS Comparing military and civilian trauma documentation and handoff, we found similarities in the types of data collected and the prioritization of information. We found that military environments involved many more contextual factors that have implications for design, such as the physical environment (eg, heat, lack of lighting, lack of power) and the potential for active combat and triage, creating additional complexity. CONCLUSIONS An ineffectiveness of communication is evident in both the civilian and military worlds. We used multiple methods of inquiry to study the information needs of trauma care and handoff, and the context of medical work in the field. Our findings informed the design and evaluation of an automated documentation tool. The data illustrated the need for more accurate recordkeeping, specifically temporal aspects, during transportation, and characterized the environment in which field testing of the developed tool will take place. The employment of a systems perspective in this project produced design insights that our team would not have identified otherwise. These insights created exciting and interesting challenges for the technical team to resolve.
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Affiliation(s)
- Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Joseph Coco
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, United States
| | - Jesse M Ehrenfeld
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sean M Bloos
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Maddry JK, Arana AA, Clemons MA, Medellin KL, Shults NM, Perez CA, Savell SC, Gutierrez XE, Reeves LK, Mora AG, Bebarta VS. Impact of a Standardized EMS Handoff Tool on Inpatient Medical Record Documentation at a Level I Trauma Center. PREHOSP EMERG CARE 2020; 25:656-663. [PMID: 32940577 DOI: 10.1080/10903127.2020.1824050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The emergency department (ED) poses challenges to effective handoff from emergency medical services (EMS) personnel to ED staff. Despite the importance of a complete and accurate patient handoff report between EMS and trauma staff, communication is often interrupted, incomplete, or otherwise ineffective. The Mechanism of injury/Medical Complaint, Injuries or Inspections head to toe, vital Signs, and Treatments (MIST) report initiative was implemented to standardize the handoff process. The objective of this study was to evaluate whether documentation of prehospital care in the inpatient medical record improved after MIST implementation. METHODS Research staff abstracted data from the EMS and inpatient medical records of trauma patients transported by EMS and treated at a Level I trauma center from January 2015 through June 2017. Data included patient demographics, mechanism and location of injury, vital signs, treatments, and period of data collection (pre-MIST and post-MIST). We summarized the MIST elements in EMS and inpatient medical records and assessed the presence or absence of data elements in the inpatient record from the EMS record and the agreement between the two sets of records over time to determine if implementation of MIST improved documentation. RESULTS We analyzed data from 533 trauma patients transported by EMS and treated in a Level I trauma center (pre-MIST: n = 281; post-MIST: n = 252). For mechanism of injury, agreement between the two records was ≥96% before and after MIST implementation. Cardiac arrest and location of injury were under-reported in the inpatient record before MIST; post-MIST, there were no significant discrepancies, indicating an improvement in reporting. Reporting of prehospital hypotension improved from 76.5% pre-MIST to 83.3% post-MIST. After MIST implementation, agreement between the EMS and inpatient records increased for the reporting of fluid administration (45.6% to 62.7%) and decreased for reporting of pain medications (72.2% to 61.9%). CONCLUSIONS The use of the standardized MIST tool for EMS to hospital patient handoff was associated with a mixed value on inpatient documentation of prehospital events. After MIST implementation, agreement was higher for mechanism and location of injury and lower for vital signs and treatments. Further research can advance the prehospital to treatment facility handoff process.
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Maddry JK, Simon EM, Reeves LK, Mora AG, Clemons MA, Shults NM, Savell S, Blessing A, Walrath BD. Impact of a Standardized Patient Hand-off Tool on Communication between Emergency Medical Services Personnel and Emergency Department Staff. PREHOSP EMERG CARE 2020; 25:530-538. [PMID: 32772874 DOI: 10.1080/10903127.2020.1808745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Handoff communication between Emergency Medical Services (EMS) and Emergency Department (ED) staff is critical to ensure quality patient care. In January 2016, the Southwest Texas Regional Advisory Council (STRAC) implemented MIST (Mechanism, Injuries, vital Signs, Treatments), a standardized EMS to ED handoff tool. The En route Care Research Center conducted a Pre-MIST implementation survey of ED staff in December 2015 and a Post-MIST follow-up survey in July 2017 to determine the impact of the MIST handoff tool on the perceived quality of transmission of pertinent patient information and in the overall handoff experience. METHODS We administered a nine-item Likert scale questionnaire to Brooke Army Military Medical Center (BAMC) ED providers and nurses before and after implementation of MIST. The questionnaire captured perceived competence and satisfaction with handoff communication (Cronbach's alpha 0.73). We analyzed responses for the total sample and by occupation (providers and nurses), and we calculated odds ratios to determine items that may be most predictive of a positive handoff experience from the perspective of the ED staff. We performed chi-square tests and reported data as percentages. RESULTS Total respondents Pre- and Post-MIST were 128 (62%) nurses and 80 (38%) providers (MDs, DOs, and PAs). Following the implementation of MIST, more respondents reported that they were "informed of prehospital treatments" (p < 0.001), that "Red/Blue Trauma Alert Criteria were conveyed" (p < 0.001), and that the "time to give the report was sufficient to convey pertinent information" (p < 0.001). Nurses more frequently reported that "Red/Blue Trauma Alert Criteria were conveyed" post-MIST (p < 0.01). Providers more frequently reported that "Assessment findings were conveyed" (p < 0.05), that they 'interrupted the report for clarification" (p < 0.04), that "time to give the report was sufficient to convey pertinent information" (p < 0.001) and that they "felt positive about the overall handoff experience" (p < 0.03) Post-MIST. Overall satisfaction with the handoff was associated with frequently being informed of prehospital treatments (OR 5.5; 2.1-14.4) and frequently receiving a copy of the prehospital record (OR 2.9; 1.1-7.2). CONCLUSIONS These data demonstrate that providers and nurses reported an improvement in the handoff experience Post-MIST. This study supports the use of a standardized handoff tool at this critical step in patient care.
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Barriers to effective EMS to emergency department information transfer at patient handover: A systematic review. Am J Emerg Med 2020; 38:1494-1503. [PMID: 32321683 DOI: 10.1016/j.ajem.2020.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/13/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Handovers of care are necessary, yet a vulnerable time for patient safety. They can either reduce the risk of medical error during transitions of care or cause direct medical or financial harm to patients due to poor communication. OBJECTIVE To review (1) observational studies that quantify the frequency of transfer of specific data points or clinician retention of information provided in prehospital verbal handoff to assess the state of EMS-to-ED handoffs; (2) surveys and interviews of prehospital and ED staff perceptions of the handover process and any perceived barriers to optimal handover found therein; (3) interventional studies that have aimed to improve the quality of EMS to ED handoffs. METHODS A systematic review of the literature was performed using Pubmed, Web of Science, Google Scholar, and Cochrane Database of Systematic Reviews and by hand-searching references of relevant articles. Articles were selected that focused on verbal and/or written handover of patient care from EMS to ED providers and that addressed the above goals. Qualitative data was extracted from the articles and assessed using thematic synthesis. RESULTS 78 articles were identified for full text review, 60 of which met inclusion criteria. Four categories of barriers emerged on thematic synthesis: educational, operational, cultural, and cognitive. Within these categories, 12 initial descriptive themes and 9 suggested interventions were identified. CONCLUSIONS Descriptive themes of disrespect & disinterest, environmental factors, redundancy, poor recall, conflicting goals and perspectives, technological issues, information degradation, information loss, lack of standardization, lack of training, delays, and lack of feedback were identified as barriers to effective EMS to ED handovers. Three categories of interventions were identified across the included interventional studies, namely technological, educational, and changes to cultural customs.
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Janagama SR, Strehlow M, Gimkala A, Rao GVR, Matheson L, Mahadevan S, Newberry JA. Critical Communication: A Cross-sectional Study of Signout at the Prehospital and Hospital Interface. Cureus 2020; 12:e7114. [PMID: 32140371 PMCID: PMC7047340 DOI: 10.7759/cureus.7114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low- and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7 to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%) and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication.
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Affiliation(s)
| | - Matthew Strehlow
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Aruna Gimkala
- Research, Gunupati Venkata Krishnareddy Emergency Management and Research Institute, Hyderabad, IND
| | - G V Ramana Rao
- Emergency Medicine Learning Centre & Research, Gunupati Venkata Krishnareddy Emergency Management and Research Institute, Hyderabad, IND
| | - Loretta Matheson
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
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Hiti EA, Tamim H, Makki M, Geha M, Kaddoura R, Obermeyer Z. Characteristics and determinants of high-risk unscheduled return visits to the emergency department. Emerg Med J 2019; 37:79-84. [PMID: 31806725 PMCID: PMC7027026 DOI: 10.1136/emermed-2018-208343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 10/16/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
Background High-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the characteristics and predictors of HRURVs to the ED. Methods Case–control study, conducted between 1 November 2014 and 31 October 2015. Cases included all HRURVs over the age of 18 that presented to the ED. Controls were selected from patients who were discharged from the ED during the study period and did not return in the next 72 hours. Controls were matched to cases based on gender, age (±5 years) and date of presentation. Results Out of 38 886 ED visits during the study period, 271 are HRURVs, giving an incidence of HRURV of 0.70% (95% CI 0.62% to 0.78%). Our final analysis includes 270 HRURV cases and 270 controls, with an in-ED mortality rate of 0.7%, intensive care unit admission of 11.1% and need for surgical intervention of 22.2%. After adjusting for other factors, HRURV cases are more likely to be discharged with a diagnosis related to digestive system or infectious disease (OR 1.64, 95% CI 1.02 to 2.65 and OR 2.81, 95% CI 1.05 to 7.51, respectively). Furthermore, presentation to the ED during off-hours is a significant predictor of HRURV (OR 1.64, 95% CI 1.11 to 2.43) as is the presence of a handover during the patient visit (OR 1.68, 95% CI 1.02 to 2.75). Conclusion HRURV is an important key quality outcome metric that reflects a subgroup of ED patients with specific characteristics and predictors. Efforts to reduce this HRURV rate should focus on interventions targeting patients discharged with digestive system, kidney and urinary tract and infectious diseases diagnosis as well as exploring the role of handover tools in reducing HRURVs.
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Affiliation(s)
- Eveline A Hiti
- Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mirabelle Geha
- Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Kaddoura
- Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Obermeyer
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
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Roosan D, Law AV, Karim M, Roosan M. Improving Team-Based Decision Making Using Data Analytics and Informatics: Protocol for a Collaborative Decision Support Design. JMIR Res Protoc 2019; 8:e16047. [PMID: 31774412 PMCID: PMC6906625 DOI: 10.2196/16047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 01/25/2023] Open
Abstract
Background According to the September 2015 Institute of Medicine report, Improving Diagnosis in Health Care, each of us is likely to experience one diagnostic error in our lifetime, often with devastating consequences. Traditionally, diagnostic decision making has been the sole responsibility of an individual clinician. However, diagnosis involves an interaction among interprofessional team members with different training, skills, cultures, knowledge, and backgrounds. Moreover, diagnostic error is prevalent in the interruption-prone environment, such as the emergency department, where the loss of information may hinder a correct diagnosis. Objective The overall purpose of this protocol is to improve team-based diagnostic decision making by focusing on data analytics and informatics tools that improve collective information management. Methods To achieve this goal, we will identify the factors contributing to failures in team-based diagnostic decision making (aim 1), understand the barriers of using current health information technology tools for team collaboration (aim 2), and develop and evaluate a collaborative decision-making prototype that can improve team-based diagnostic decision making (aim 3). Results Between 2019 to 2020, we are collecting data for this study. The results are anticipated to be published between 2020 and 2021. Conclusions The results from this study can shed light on improving diagnostic decision making by incorporating diagnostics rationale from team members. We believe a positive direction to move forward in solving diagnostic errors is by incorporating all team members, and using informatics. International Registered Report Identifier (IRRID) DERR1-10.2196/16047
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Affiliation(s)
- Don Roosan
- Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States
| | - Anandi V Law
- Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States
| | - Mazharul Karim
- Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States
| | - Moom Roosan
- Chapman University, School of Pharmacy, Irvine, CA, United States
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Andersson Hagiwara M, Lundberg L, Sjöqvist BA, Maurin Söderholm H. The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2019; 3:300-328. [PMID: 35415430 PMCID: PMC8982745 DOI: 10.1007/s41666-019-00053-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/03/2022]
Abstract
Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.
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Affiliation(s)
- Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Lars Lundberg
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Bengt Arne Sjöqvist
- Department of Electrical Engineering, Biomedical Signals and Systems, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Hanna Maurin Söderholm
- PreHospen-Centre for Prehospital Research, Faculty of Librarianship, Information, Education and IT, University of Borås, SE-501 90 Borås, Sweden
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Hagiwara MA, Magnusson C, Herlitz J, Seffel E, Axelsson C, Munters M, Strömsöe A, Nilsson L. Adverse events in prehospital emergency care: a trigger tool study. BMC Emerg Med 2019; 19:14. [PMID: 30678636 PMCID: PMC6345067 DOI: 10.1186/s12873-019-0228-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. Methods We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria. Results The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9–5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1–0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew. Conclusions There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid. Electronic supplementary material The online version of this article (10.1186/s12873-019-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
| | - Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Elin Seffel
- Department of Ambulance Care, Södra Älvsborg Hospital (SÄS), SE-501 82, Borås, Sweden
| | - Christer Axelsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Monica Munters
- Department of Ambulance Care, Region of Dalarna, SE-791 29, Falun, Sweden
| | - Anneli Strömsöe
- School of Health, Care and Social Welfare, Mälardalens högskola, SE-721 23, Västerås, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
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Hovenkamp GT, Olgers TJ, Wortel RR, Noltes ME, Dercksen B, Ter Maaten JC. The satisfaction regarding handovers between ambulance and emergency department nurses: an observational study. Scand J Trauma Resusc Emerg Med 2018; 26:78. [PMID: 30201007 PMCID: PMC6131795 DOI: 10.1186/s13049-018-0545-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A thorough handover in the emergency department (ED) is of great importance for improving the quality and safety in the chain of care. The satisfaction of handover may reflect the quality of handover. Research to discover the variables influencing the satisfaction of handovers is scarce. The goal of this study was to determine the factors influencing the satisfaction regarding handovers from ambulance and ED nurses. METHODS We performed a prospective observational study in the University Medical Center of Groningen. Data regarding prehospital-hospital handovers has been collected by observing handovers and assessing patient chart information. Data regarding the satisfaction has been collected with a questionnaire including a 5-point scale for the level of satisfaction. RESULTS In total, 97 handovers were observed and 97 ambulance nurses and 89 ED nurses completed the questionnaire. The satisfaction of ambulance nurses showed a negative correlation with the waiting time prior to handover (r = -.287, p = .004) and a positive correlation with the presence of a physician in the receiving team (r = .224, p = .028). The satisfaction of ED nurses showed a positive correlation with the use of the ABCDE (r = .288, p = .006) and AMPLE instrument (r = .208, p = .050). CONCLUSION The satisfaction of ambulance and ED nurses as sender or receiver of the handover is determined by different factors. The satisfaction of ambulance nurses is mainly affected by the waiting time and presence of a physician, while the satisfaction of ED nurses is affected by the use of handover instruments and the completeness of medical information.
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Affiliation(s)
- Gijs Thomas Hovenkamp
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Tycho Joan Olgers
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands.
| | - Remco Robert Wortel
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Milou Esmée Noltes
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Bert Dercksen
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Jan Cornelis Ter Maaten
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
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Sumner BD, Grimsley EA, Cochrane NH, Keane RR, Sandler AB, Mullan PC, O'Connell KJ. Videographic Assessment of the Quality of EMS to ED Handoff Communication During Pediatric Resuscitations. PREHOSP EMERG CARE 2018; 23:15-21. [PMID: 30118642 DOI: 10.1080/10903127.2018.1481475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The National Association of Emergency Medical Services (EMS) Physicians emphasizes the importance of high quality communication between EMS providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration. OBJECTIVE This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations. METHODS/DESIGN We conducted a retrospective review of video recordings of pediatric patients who required critical care ("resuscitation") in the ED between January 2014 and February 2016 at a Level 1 pediatric trauma center. Handoff quality between EMS and emergency department teams was assessed for completeness, timeliness, and efficiency. Institutional review board approval was obtained. RESULTS Sixty-eight resuscitations were reviewed; 28% presented in cardiac arrest, requiring cardiopulmonary resuscitation (CPR). Completeness of information communicated was variable and included chief complaint (88%), prehospital interventions (81%), physical exam findings (63%), medical history (59%), age (56%), and weight (20%). Completeness of specific vital sign reporting included: respiratory rate (53%), heart rate (43%), oxygen saturation (39%), and blood pressure (31%). Timeliness of communication included median patient handoff and report times of 50 seconds [IQR 30,74] and 108 seconds [IQR 62,252], respectively. Inefficient communication occurred in 87% of handoffs, including interruptions by ED staff (51%), questions from the ED physician team leader asking for information already communicated (40%), and questions by ED physician team leader requesting information not yet communicated (65%). When comparing non-CPR to CPR cases, only timeliness of patient handoff was significantly different for those patients receiving prehospital CPR. CONCLUSION Handoff communication between EMS and ED teams during pediatric resuscitation was frequently incomplete and inefficient. Future educational and quality improvement interventions could aim to improve the quality of handoff communication for this patient population.
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Reimer AP, Alfes CM, Rowe AS, Rodriguez-Fox BM. Emergency Patient Handoffs: Identifying Essential Elements and Developing an Evidence-Based Training Tool. J Contin Educ Nurs 2018; 49:34-41. [PMID: 29384586 DOI: 10.3928/00220124-20180102-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 10/25/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient handoffs between care teams have been recognized as a major patient safety risk due to inadequate exchange or loss of critical information, especially during emergent patient transfers. The purpose of this literature review was to identify the essential elements of effective patient handoffs in emergency situations to develop a standardized tool to support a structured patient handoff procedure capable of guiding education and training. METHOD A literature search of handoff procedures and patient transfers was conducted using the Cumulative Index to Nursing and Allied Health Literature and PubMed between 2008 and 2015. RESULTS Two global themes were identified-Crew Interactions, and Essential Data Elements-resulting in a tool containing 30 objective and five subjective items. CONCLUSION Through the literature review, synthesis, and workgroup consensus, we developed a standardized tool to guide standardized education, training, and future inquiry in prehospital and emergent patient handoffs. J Contin Educ Nurs. 2018;49(1):34-41.
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The feasibility, acceptability and preliminary testing of a novel, low-tech intervention to improve pre-hospital data recording for pre-alert and handover to the Emergency Department. BMC Emerg Med 2018; 18:16. [PMID: 29940885 PMCID: PMC6019792 DOI: 10.1186/s12873-018-0168-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality. Methods This study aimed to measure the feasibility and acceptability of a novel, low tech intervention, designed to support clinical information recording and delivery during pre-alert and handover within the pre-hospital and ED setting. A simple pre and post-test design was used with a historical control. Eligible participants included all ambulance clinicians based at one large city Ambulance Station (n = 69) and all nursing and physician staff (n = 99) based in a city Emergency Department. Results Twenty five (36%) ambulance clinicians responded to the follow-up survey. Most felt both the pre-alert and handover components of the card were either ‘useful-very useful’ (n = 23 (92%); and n = 18 (72%) respectively. Nineteen (76%) used the card to record clinical information and almost all (n = 23 (92%) felt it ‘useful’ to ‘very useful’ in supporting pre-alert. Similarly, 65% (n = 16) stated they ‘often’ or ‘always’ used the card to support handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables. Results from the post-test survey measuring ED staff (n = 37) perceptions of handover demonstrated small (p < 0.05) improvements in handover in 3/5 domains measured. Conclusion This novel low-tech intervention was highly acceptable to ambulance clinician participants, improving their data recording and information exchange processes. However, further well conducted studies are required to test the impact of this intervention on information exchange during pre-alert and handover. Electronic supplementary material The online version of this article (10.1186/s12873-018-0168-3) contains supplementary material, which is available to authorized users.
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Fedor PJ, Burns B, Lauria M, Richmond C. Major Trauma Outside a Trauma Center: Prehospital, Emergency Department, and Retrieval Considerations. Emerg Med Clin North Am 2017; 36:203-218. [PMID: 29132578 DOI: 10.1016/j.emc.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward.
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Affiliation(s)
- Preston J Fedor
- Department of Emergency Medicine, Division of Prehospital, Austere and Disaster Medicine, University of New Mexico, 1 University of New Mexico, MSC11 6025, Albuquerque, NM 87131-0001, USA.
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, NSW 2200, Australia; Sydney University, Sydney, NSW, Australia
| | - Michael Lauria
- Dartmouth-Hitchcock Advanced Response Team (DHART), Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Clare Richmond
- Greater Sydney Area HEMS, NSW Ambulance, NSW 2200, Australia; Royal Prince Alfred Hospital, Sydney, Australia
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Rosen T, Lien C, Stern ME, Bloemen EM, Mysliwiec R, McCarthy TJ, Clark S, Mulcare MR, Ribaudo DS, Lachs MS, Pillemer K, Flomenbaum NE. Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect. J Emerg Med 2017; 53:573-582. [PMID: 28712685 DOI: 10.1016/j.jemermed.2017.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/28/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency Medical Services (EMS) providers, who perform initial assessments of ill and injured patients, often in a patient's home, are uniquely positioned to identify potential victims of elder abuse, neglect, or self-neglect. Despite this, few organized programs exist to ensure that EMS concerns are communicated to or further investigated by other health care providers, social workers, or the authorities. OBJECTIVE To explore attitudes and self-reported practices of EMS providers surrounding identification and reporting of elder mistreatment. METHODS Five semi-structured focus groups with 27 EMS providers. RESULTS Participants reported believing they frequently encountered and were able to identify potential elder mistreatment victims. Many reported infrequently discussing their concerns with other health care providers or social workers and not reporting them to the authorities due to barriers: 1) lack of EMS protocols or training specific to vulnerable elders; 2) challenges in communication with emergency department providers, including social workers, who are often unavailable or not receptive; 3) time limitations; and 4) lack of follow-up when EMS providers do report concerns. Many participants reported interest in adopting protocols to assist in elder protection. Additional strategies included photographically documenting the home environment, additional training, improved direct communication with social workers, a dedicated location on existing forms or new form to document concerns, a reporting hotline, a system to provide feedback to EMS, and community paramedicine. CONCLUSIONS EMS providers frequently identify potential victims of elder abuse, neglect, and self-neglect, but significant barriers to reporting exist. Strategies to empower EMS providers and improve reporting were identified.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Cynthia Lien
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Michael E Stern
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | | | - Regina Mysliwiec
- Department of Emergency Medicine, Oregon Health Sciences University, Astoria, Oregon
| | - Thomas J McCarthy
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Mary R Mulcare
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Daniel S Ribaudo
- Emergency Medical Services, New York-Presbyterian Hospital, New York, New York
| | - Mark S Lachs
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York; Emergency Medical Services, New York-Presbyterian Hospital, New York, New York
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Goldberg SA, Porat A, Strother CG, Lim NQ, Wijeratne HRS, Sanchez G, Munjal KG. Quantitative Analysis of the Content of EMS Handoff of Critically Ill and Injured Patients to the Emergency Department. PREHOSP EMERG CARE 2016; 21:14-17. [PMID: 27420753 DOI: 10.1080/10903127.2016.1194930] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is transferred from one healthcare professional to another. Patient handoff is an integral component of quality patient care and is increasingly identified as a potential source of medical error. However, evaluation of handoff from field providers to ED personnel is limited. We here present a quantitative analysis of the information transferred from EMS providers to ED physicians during handoff of critically ill and injured patients. METHODS This study was conducted at an urban academic medical center with an emergency department census of greater than 100,000 visits annually. All patients arriving to our institution by EMS and meeting predefined triage criteria are brought immediately to the ED resuscitation area upon EMS arrival. Handoff from EMS to ED providers occurring in the resuscitation area was observed and audio recorded by trained research assistants and subsequently coded for content. The emergency department team as well as EMS were blinded to study design. RESULTS Ninety patient handoffs were evaluated. In 78% (95%CI = 70.0-86.7) of all handoffs, EMS provided a chief concern. In 58% (95%CI = 47.7-67.7) of handoffs EMS provided a description of the scene and in 57% (95%CI = 46.7-66.7) they provided a complete set of vital signs. In 47% (95%CI = 31.3-57.5) of handoffs pertinent physical exam findings were described. The EMS provider gave an overall assessment of the patient's clinical status in 31% (95%CI = 21.6-40.3) of cases. Significantly more paramedic handoffs included vital signs (70% vs. 37%, χ2 = 9.69, p = 0.002) and physical exam findings (63% vs. 23%, χ2 = 14.11, p < 0.001). Paramedics were more likely to provide an overall assessment (39% vs. 17%, χ2 = 4.71, p < 0.05). CONCLUSIONS While patient handoff is a critical component of safe and effective patient care, our study confirms previous literature demonstrating poor quality handoff from EMS to ED providers in critically ill and injured patients. Our analysis demonstrates the need for further training in the provision of patient handoff.
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Alfes CM, Reimer A. Joint Training Simulation Exercises: Missed Elements in Prehospital Patient Handoffs. Clin Simul Nurs 2016. [DOI: 10.1016/j.ecns.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Williams GW, Stephens CT, Hagberg C. Trauma Hand-Offs: Moving Patients Through Multiple Phases and Locations of Care. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shelton D, Sinclair P. Availability of ambulance patient care reports in the emergency department. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu209478.w3889. [PMID: 26893895 PMCID: PMC4752710 DOI: 10.1136/bmjquality.u209478.w3889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/20/2015] [Accepted: 01/06/2016] [Indexed: 11/04/2022]
Abstract
Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of EMS reports. Implementation of change strategies did not result in a significant improvement in the percentage of EMS reports available to emergency physicians at the time of initial patient assessment. However, tracking both external and internal processes that influence EMS report availability showed the internal process time from fax report receipt to distribution significantly improved. This improvement reflected the change strategies that were all directed at improving the internal process. EMS patient care reports are more efficiently processed and distributed in the ED due to change strategies implemented that targeted the ED's internal process of EMS report distribution. The external process responsible for transmitting EMS reports to the ED is the limiting factor that prevents consistent timely access of EMS reports by emergency physicians and will require dedicated improvement strategies.
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Zakrison TL, Rosenbloom B, McFarlan A, Jovicic A, Soklaridis S, Allen C, Schulman C, Namias N, Rizoli S. Lost information during the handover of critically injured trauma patients: a mixed-methods study. BMJ Qual Saf 2015; 25:929-936. [PMID: 26545705 DOI: 10.1136/bmjqs-2014-003903] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. METHODS A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. RESULTS Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. CONCLUSION Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover.
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Affiliation(s)
| | - Brittany Rosenbloom
- Faculty of Medicine, Institute of Medical Sciences, Toronto, Ontario, Canada
| | - Amanda McFarlan
- Departments of Surgery and Laboratory Medicine, Trauma Program and Transfusion Medicine, Toronto, Ontario, Canada
| | - Aleksandra Jovicic
- Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Center for Addictions and Mental Health, Toronto, Ontario, Canada
| | - Casey Allen
- Department of Surgery, Trauma & Surgical Critical Care, Miami, Florida, USA
| | - Carl Schulman
- Department of Surgery, Trauma & Surgical Critical Care, Miami, Florida, USA
| | - Nicholas Namias
- Department of Surgery, University of Miami, Miami, Florida, USA
| | - Sandro Rizoli
- Departments of Surgery and Laboratory Medicine, Trauma Program and Transfusion Medicine, Toronto, Ontario, Canada
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Rooks HJ, Anthony JR, Sexton KW, Marshall AP, Guillamondegul OD, Ehrenfeld JM, Shack RB, Thayer WP. Transfers for Hand Surgery Correlate with Increased Reoperations for Complications. Am Surg 2015. [DOI: 10.1177/000313481508101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Wrist, hand, and finger trauma are the most common nonlethal injuries presenting to emergency departments. In Tennessee, lack of available hand care, particularly the need for emergency hand surgery, could be detrimental to patient outcomes. This is a retrospective outcomes study of patients requiring revisional hand surgeries. Patients were identified and stratified by distance to Vanderbilt University Medical Center (VUMC) to determine if patient complications increase with distance from VUMC. As distance of patient county of residence from VUMC increased, per cent of patients without a complication decreased ( P < 0.0001). Counties without 24/7 comprehensive hand call also showed a distance difference in complication rates. Per capita income and mean household income showed no effect on complications. Distance from treating facility is correlated with patient outcomes and need for revisional surgery. Limitations in care availability in Tennessee are not specific to hand surgery. If the trend toward poorer outcomes as a result of limited local care availability extends to other specialties, this could have implications regarding health-care realignment. Specifically for patients with complex injuries or conditions that will be referred to centralized flagship hospitals, increases in patient travel may limit positive outcomes.
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Affiliation(s)
- Hunter J. Rooks
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua R. Anthony
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Kevin W. Sexton
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andre P. Marshall
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jesse M. Ehrenfeld
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - R. Bruce Shack
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wesley P. Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Waldron R, Sixsmith DM. Emergency physician awareness of prehospital procedures and medications. West J Emerg Med 2015; 15:504-10. [PMID: 25035759 PMCID: PMC4100859 DOI: 10.5811/westjem.2014.2.18651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 02/13/2014] [Accepted: 02/21/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Maintaining patient safety during transition from prehospital to emergency department (ED) care depends on effective handoff communication between providers. We sought to determine emergency physicians’ (EP) knowledge of the care provided by paramedics in terms of both procedures and medications, and whether the use of a verbal report improved physician accuracy. Methods We conducted a 2-phase observational survey of a convenience sample of EPs in an urban, academic ED. In this large ED paramedics have no direct contact with physicians for non-critical patients, giving their report instead to the triage nurse. In Phase 1, paramedics gave verbal report to the triage nurse only. In Phase 2, a research assistant (RA) stationed in triage listened to this report and then repeated it back verbatim to the EPs caring for the patient. The RA then queried the EPs 90 minutes later regarding their patients’ prehospital procedures and medications. We compared the accuracy of these 2 reporting methods. Results There were 163 surveys completed in Phase 1 and 116 in Phase 2. The oral report had no effect on EP awareness that the patient had been brought in by ambulance (86% in Phase 1 and 85% in Phase 2.) The oral report did improve EP awareness of prehospital procedures, from 16% in Phase 1 to 45% in Phase 2, OR=4.28 (2.5–7.5). EPs were able to correctly identify all oral medications in 18% of Phase 1 cases and 47% of Phase 2 cases, and all IV medications in 42% of Phase 1 cases and 50% of Phase 2 cases. The verbal report led to a mild improvement in physician awareness of oral medications given, OR=4.0 (1.09–14.5), and no improvement in physician awareness of IV medications given, OR=1.33 (0.15–11.35). Using a composite score of procedures plus oral plus IV medications, physicians had all three categories correct in 15% of Phase 1 and 39% of Phase 2 cases (p<0.0001). Conclusion EPs in our ED were unaware of many prehospital procedures and medications regardless of the method used to provide this information. The addition of a verbal hand-off report resulted in a modest improvement in overall accuracy.
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Affiliation(s)
- Rachel Waldron
- New York Hospital Queens, Department of Emergency Medicine, Flushing, New York
| | - Diane M Sixsmith
- New York Hospital Queens, Department of Emergency Medicine, Flushing, New York
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Nakada TA, Masunaga N, Nakao S, Narita M, Fuse T, Watanabe H, Mizushima Y, Matsuoka T. Development of a prehospital vital signs chart sharing system. Am J Emerg Med 2015; 34:88-92. [PMID: 26508581 DOI: 10.1016/j.ajem.2015.09.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival. METHODS Fifty trauma patients, transferred to a level I trauma center in Japan, were studied. The primary outcome variable was the number of prehospital vital signs shared with the trauma center prior to hospital arrival. RESULTS The prehospital vital signs chart sharing system significantly increased the number of prehospital vital signs, including blood pressure, heart rate, and oxygen saturation, shared with the in-hospital team at a remote trauma center prior to patient arrival at the hospital (P < .0001). There were significant differences in prehospital vital signs during ambulance transfer between patients who had severe bleeding and non-severe bleeding within 24 hours after injury onset. CONCLUSIONS Vital signs data collected during ambulance transfer via patient monitors could be automatically converted to easily visible patient charts and effectively shared with the remote trauma center prior to hospital arrival. The prehospital vital signs chart sharing system increased the number of precise vital signs shared prior to patient arrival at the hospital, which can potentially contribute to better trauma care without increasing labor and reduce information loss during clinical handover.
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Affiliation(s)
- Taka-aki Nakada
- Senshu Trauma and Critical Care Center, Osaka, Japan; Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | | | - Shota Nakao
- Senshu Trauma and Critical Care Center, Osaka, Japan
| | - Maiko Narita
- Senshu Trauma and Critical Care Center, Osaka, Japan
| | - Takashi Fuse
- Senshu Trauma and Critical Care Center, Osaka, Japan
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Panchal AR, Gaither JB, Svirsky I, Prosser B, Stolz U, Spaite DW. The Impact of Professionalism on Transfer of Care to the Emergency Department. J Emerg Med 2015; 49:18-25. [DOI: 10.1016/j.jemermed.2014.12.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/10/2014] [Accepted: 12/22/2014] [Indexed: 11/26/2022]
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Ebben RHA, van Grunsven PM, Moors ML, Aldenhoven P, de Vaan J, van Hout R, van Achterberg T, Vloet LCM. A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study. Scand J Trauma Resusc Emerg Med 2015; 23:33. [PMID: 25887239 PMCID: PMC4422253 DOI: 10.1186/s13049-015-0113-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/09/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To standardize patient handover in the chain of emergency care a handover guideline was developed. The main guideline recommendation is to use the DeMIST model (Demographics, Mechanism of Injury/illness, Injury/Illness, Signs, Treatment given) to structure pre-hospital notification and handover. To benefit from the new guideline, guideline adherence is necessary. As adherence to guidelines in emergency care settings is variable, there is a need to systematically implement the new guideline. For implementation of the guideline we developed a e-learning program tailored to influencing factors. The aim of the study was to evaluate the effectiveness of this e-learning program to improve emergency care professionals' adherence to the handover guideline during pre-hospital notification and handover in the chain of emergency medical service (EMS), emergency medical dispatch (EMD), and emergency department (ED). METHODS A prospective pre-test post-test study was conducted. The intervention was a tailored e-learning program that was offered to ambulance crew and emergency medical dispatchers (n=88). Data on adherence included pre-hospital notifications and handovers and were collected through observations and audiotapes before and after the e-learning program. Data were analyzed using X(2)-tests and t-tests. RESULTS In total, 78/88 (88.6%) professionals followed the e-learning program. During pre- and post-test, 146 and 169 handovers were observed respectively. After the e-learning program, no significant difference in the number of handovers with the DeMIST model (77.9% vs. 73.1%, p=.319) and the number of handovers with the correct sequence of the DeMIST model (69.9% vs. 70.5%, p=.159) existed. During the handover, the number of questions by ED staff and interruptions significantly increased from 49.0% to 68.9% and from 15.2% to 52.7% respectively (both p=.000). Most handovers were performed after patient transfer, this did not change after the intervention (p=.167). The number of handovers where information was documented during handover slightly increased from 26.9% to 29.3% (p=.632). CONCLUSIONS The tailored e-learning program did not improve adherence to a handover guideline in the chain of emergency care. Results show a relatively high baseline adherence rate to usage and correct sequence of the DeMIST model. Improvements in the handover process can be made on the documentation of information during handover, the number of interruptions and questions, and the handover moment.
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Affiliation(s)
- Remco H A Ebben
- Research department acute care, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Pierre M van Grunsven
- Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands.
| | - Marie Louise Moors
- Emergency Department, Radboud university medical center, Nijmegen, the Netherlands.
| | - Peter Aldenhoven
- Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands.
| | - Jordan de Vaan
- Emergency Department, Radboud university medical center, Nijmegen, the Netherlands.
| | - Roger van Hout
- Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands.
| | - Theo van Achterberg
- Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium. .,Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, the Netherlands.
| | - Lilian C M Vloet
- Research department acute care, HAN University of Applied Sciences, Nijmegen, the Netherlands. .,Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
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Meisel ZF, Shea JA, Peacock NJ, Dickinson ET, Paciotti B, Bhatia R, Buharin E, Cannuscio CC. Optimizing the Patient Handoff Between Emergency Medical Services and the Emergency Department. Ann Emerg Med 2015; 65:310-317.e1. [DOI: 10.1016/j.annemergmed.2014.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/21/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
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Wood K, Crouch R, Rowland E, Pope C. Clinical handovers between prehospital and hospital staff: literature review. Emerg Med J 2014; 32:577-81. [PMID: 25178977 DOI: 10.1136/emermed-2013-203165] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/10/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical handover plays a vital role in patient care and has been investigated in hospital settings, but less attention has been paid to the interface between prehospital and hospital settings. This paper reviews the published research on these handovers. METHODS A computerised literature search was conducted for papers published between 2000 and 2013 using combinations of terms: 'handover', 'handoff', 'prehospital', 'ambulance', 'paramedic' and 'emergency' and citation searching. Papers were assessed and included if determined to be at least moderate quality with a primary focus on prehospital to hospital handover. FINDINGS 401 studies were identified, of which 21 met our inclusion criteria. These revealed concerns about communication and information transfer, and themes concerning context, environment and interprofessional relationships. It is clear that handover exchanges are complicated by chaotic and noisy environments, lack of time and resources. Poor communication is linked to behaviours such as not listening, mistrust and misunderstandings between staff. While standardisation is offered as a solution, notably in terms of the use of mnemonics (alphabetical memory aids), evidence for benefit appears inconclusive. CONCLUSIONS This review raises concerns about handovers at the interface between prehospital and hospital settings. The quality of existing research in this area is relatively poor and further high-quality research is required to understand this important part of emergency care. We need to understand the complexity of handover better to grasp the challenges of context and interprofessional relationships before we reach for tools and techniques to standardise part of the handover process.
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Affiliation(s)
- Kate Wood
- Isle of Wight Ambulance Service, Newport, UK
| | - Robert Crouch
- Emergency Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emma Rowland
- Florence Nightingale School of Nursing and Midwifery, Kings College London, London, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Curfman D, Connor LT, Moy HP, Heitsch L, Panagos P, Lee JM, Tan DK, Ford AL. Accuracy of emergency medical services-reported last known normal times in patients suspected with acute stroke. Stroke 2014; 45:1275-9. [PMID: 24643409 PMCID: PMC4006297 DOI: 10.1161/strokeaha.113.003955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The last known normal (LKN) time is a critical determinant of IV tissue-type plasminogen activator (IV tPA) eligibility; however, the accuracy of emergency medical services (EMS)-reported LKN times is unknown. We determined the congruence between neurologist-determined and EMS-reported LKN times and identified predictors of incongruent LKN times. METHODS We prospectively collected EMS-reported LKN times for patients brought into the emergency department with suspected acute stroke and calculated the absolute difference between the neurologist-determined and EMS-reported LKN times (|ΔLKN|). We determined the rate of inappropriate IV tPA use if EMS-reported times had been used in place of neurologist-determined times. Univariate and multivariable linear regression assessed for any predictors of prolonged |ΔLKN|. RESULTS Of 251 patients, mean and median |ΔLKN| were 28 and 0 minutes, respectively. |ΔLKN| was <15 minutes in 91% of the entire cohort and <15 minutes in 80% of patients with a diagnosis of stroke (n=86). Of patients who received IV tPA, none would have been incorrectly excluded from IV tPA if the EMS LKN time had been used. Conversely, of patients who did not receive IV tPA, 6% would have been incorrectly included for IV tPA consideration had the EMS time been used. In patients with wake-up stroke symptoms, EMS underestimated LKN times: mean neurologist LKN time-EMS LKN time=208 minutes. The presence of wake-up stroke symptoms (P<0.0001) and older age (P=0.019) were independent predictors of prolonged |ΔLKN|. CONCLUSIONS EMS-reported LKN times were largely congruent with neurologist-determined times. Focused EMS training regarding wake-up stroke symptoms may further improve accuracy.
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Affiliation(s)
- David Curfman
- Department of Neurology, Washington University School of Medicine
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine
- Department of Radiology, Washington University School of Medicine
| | - Hawnwan Philip Moy
- Department of Emergency Medicine, Washington University School of Medicine
| | - Laura Heitsch
- Department of Emergency Medicine, Washington University School of Medicine
| | - Peter Panagos
- Department of Neurology, Washington University School of Medicine
- Department of Emergency Medicine, Washington University School of Medicine
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine
- Department of Radiology, Washington University School of Medicine
| | - David K. Tan
- Department of Emergency Medicine, Washington University School of Medicine
| | - Andria L. Ford
- Department of Neurology, Washington University School of Medicine
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Vergales J, Addison N, Vendittelli A, Nicholson E, Carver DJ, Stemland C, Hoke T, Gangemi J. Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery. Am J Med Qual 2014; 30:119-25. [PMID: 24443318 DOI: 10.1177/1062860613518419] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity.
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Affiliation(s)
| | - Nancy Addison
- University of Virginia Health System, Charlottesville, VA
| | | | | | | | | | - Tracey Hoke
- University of Virginia Health System, Charlottesville, VA
| | - James Gangemi
- University of Virginia Health System, Charlottesville, VA
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Bledsoe BE, Wasden C, Johnson L. Electronic Prehospital Records are Often Unavailable for Emergency Department Medical Decision Making. West J Emerg Med 2013; 14:482-8. [PMID: 24106547 PMCID: PMC3789913 DOI: 10.5811/westjem.2013.1.12665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 10/04/2012] [Accepted: 01/15/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION To determine emergency physician (EP) opinions of prehospital patient care reports (PCRs) and whether such reports are available at the time of emergency department (ED) medical decision-making. METHODS Prospective, cross-sectional, electronic web-based survey of EPs regarding preferences and availability of prehospital PCRs at the time of ED medical decision-making. RESULTS We sent the survey to 1,932 EPs via 4 American College of Emergency Physicians (ACEP) email lists. As a result, 228 (11.8%) of email list members from 31 states and the District of Columbia completed the survey. Most respondents preferred electronic prehospital PCRs as opposed to handwritten prehospital PCRs (52.2% [95% confidence interval (CI): 49.1, 55.3] vs. 17.1% [95%CI: 11.7, 22.5]). The remaining respondents (30.5% [95%CI: 26.0, 35.0]) had no preference or had seen only one type of PCR. Of the respondents, 45.6% [95%CI: 42.1, 48.7] stated PCRs were "very important" while 43.0% [95% CI: 39.3, 46.7] rated PCRs as "important" in their ED practice. Most respondents (79.6% [95%CI: 76.5, 82.7]) reported electronic prehospital PCRs were available ≤50% of the time for medical decision-making while 20.4% [95%CI: 9.2, 31.6] reported that electronic prehospital PCRs were available > 50% of the time (P=0.00). A majority of participants (77.6% [95%CI: 74.5, 80.7]) reported that handwritten prehospital PCRs were available ≥ 50% while 22.4% [95%CI: 11.8, 33.0] of the time for medical decision-making (P=0.00). CONCLUSION EPs in this study felt that prehospital PCRs were important to their ED practice and preferred electronic prehospital PCRs over handwritten PCRs. However, most electronic prehospital PCRs were unavailable at the time of ED medical decision-making. Although handwritten prehospital PCRs were more readily available, legibility and accuracy were reported concerns. This study suggest that strategies should be devised to improve the overall accuracy of PCRs and assure that electronic prehospital PCRs are delivered to the receiving ED in time for consideration in ED medical decision-making.
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Affiliation(s)
- Bryan E Bledsoe
- University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada ; MedicWest Ambulance/American Medical Response, Las Vegas, Nevada
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