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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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Elliott CG, Notario L, Wong B, Javidan AP, Pannell D, Nathens AB, Tien H, Johnston M, Thomas-Boaz W, Freedman C, da Luz L. Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis. CAN J EMERG MED 2023; 25:421-428. [PMID: 37087711 DOI: 10.1007/s43678-023-00503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/28/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Patient handover between paramedics and the trauma team is vulnerable to communication errors that may adversely affect patient care. This study assesses the feasibility of a handover tool, IMIST-AMBO (acronym of categories), implementation in the trauma bay and evaluates the degree to which it improves handover metrics. METHODS This is a prospective observational cohort study conducted at Canada's largest level-one trauma center. Feasibility of the tool implementation and improvement in handover metrics were assessed. Strategies for implementation included distribution of an educational video and posters, and point-of-care reminders in the trauma bay. Two reviewers independently assessed video recordings of handovers to evaluate handover metrics. Findings were compared to data obtained during a knowledge gap analysis conducted prior to the initiation of this study at the same institution. RESULTS Over 13 weeks (August to November 2020), 140 videos were recorded, of which 80 used the IMIST-AMBO tool (compliance of 57%). Paramedic adherence to the handover structure occurred in 70.4% of cases, with greater adherence to the IMIST (82.2%) compared to the AMBO (47.1%) section. The mean (± standard deviation) handover duration was shorter (1 min:58 s ± 0:44 s during implementation vs. 2 min:47 s ± 1:14 s pre-implementation, [p < 0.001]). Frequency of parallel conversations and informal handovers improved (61% to 30% and 65% to 13%, [p < 0.001], respectively). Interruptions during the handover decreased from 3.05 (± 1.95) to 1.5 (± 1.7), p < 0.001. The tool was received favorably among study participants. CONCLUSION The IMIST-AMBO tool reduced the frequency of interruptions, parallel conversations, and informal handovers during paramedic-trauma team handovers at our institution. The quality and amount of information communicated per handover improved, all with a decrease in handover duration. The IMIST-AMBO tool may be applied to other trauma centers across Canada, or more broadly on an international scale.
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Affiliation(s)
- Cara G Elliott
- Department of Obstetrics and Gynaecology, Western University, London, ON, Canada
| | - Lowyl Notario
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Wong
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arshia P Javidan
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dylan Pannell
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Avery B Nathens
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Homer Tien
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Will Thomas-Boaz
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Corey Freedman
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Luis da Luz
- Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Wang B, Zou G, Zheng M, Chen C, Teng W, Lu Q. Correlation between the quality of nursing handover, job satisfaction, and group cohesion among psychiatric nurses. BMC Nurs 2022; 21:86. [PMID: 35410223 PMCID: PMC9003974 DOI: 10.1186/s12912-022-00864-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Nursing handovers are a critical component of patient safety. Researchers have performed many primary studies in this field, mainly reporting findings from changes in nursing handover patterns. However, few quantitative studies have explored the factors that influence handover quality. Therefore, this study aimed to investigate the quality of handovers and explore the associations between handover quality, job satisfaction, and group cohesion among psychiatric nurses. Methods This cross-sectional study included 186 registered psychiatric nurses from a Chinese hospital, who responded to the Handover Evaluation Scale, McCloskey/Mueller Satisfaction Scale, and Group Cohesion Scale. Bootstrap analyses were used to evaluate the mediating effect between variables. Results The average item score for handover quality was (5.85 ± 1.14), and job satisfaction and group cohesion could predict the variance of handover quality. Job satisfaction could partially mediate between group cohesion and handover quality, and the value of the mediating effect was 45.77%. Conclusion The quality of psychiatric nursing handovers has enhanced space. Thus, hospital managers should take various measures to strengthen group cohesion and promote job satisfaction, both of which help improve the quality of psychiatric nursing handovers.
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Affiliation(s)
- Bin Wang
- Department of Psychiatric, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Guiyuan Zou
- Department of Psychiatric, Shandong Mental Health Center, Shandong University, 49 Wenhua East Road, Jinan, 250014, Shandong, China.
| | - Mei Zheng
- Department of Psychiatric, Shandong Mental Health Center, Shandong University, 49 Wenhua East Road, Jinan, 250014, Shandong, China
| | - Chen Chen
- Department of Psychiatric, Shandong Mental Health Center, Shandong University, 49 Wenhua East Road, Jinan, 250014, Shandong, China
| | - Weiyu Teng
- Department of Psychiatric, Shandong Mental Health Center, Shandong University, 49 Wenhua East Road, Jinan, 250014, Shandong, China
| | - Qinghua Lu
- Department of Psychiatric, Shandong Mental Health Center, Shandong University, 49 Wenhua East Road, Jinan, 250014, Shandong, China
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Mastrogiovanni MJ, Michelle Moccia J. Optimizing handover in patients with stroke symptoms utilizing an organized protocol between emergency department providers and emergency medical personnel. Int Emerg Nurs 2022; 61:101129. [DOI: 10.1016/j.ienj.2021.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/20/2021] [Accepted: 12/13/2021] [Indexed: 11/05/2022]
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Guasconi M, Bonacaro A, Tamagnini E, Biral S, Brigliadori L, Borioni S, Collura D, Fontana S, Ingallina G, Bassi MC, Lucenti E, Artioli G. Handover methods between local emergency medical services and Accident and Emergency: is there a gold standard? A scoping review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022288. [PMID: 36043950 PMCID: PMC9534252 DOI: 10.23750/abm.v93i4.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pre-hospital emergency medical systems do not appear to work totally coordinated with Accident and Emergency (A&E). Often, patient admission to A&E is marked by scarce attention to the handover between the respective healthcare professionals. This phenomenon is potentially dangerous because it exposes patients to the risk of errors in a context where the patients' critical or progressing conditions must not be worsened by avoidable errors of communication between professionals. OBJECTIVES to describe the evidence concerning handover between local emergency medical services and A&E. ELIGIBILITY CRITERIA pre-hospital emergency medical and A&E professionals, setting defined as within A&E, articles on pre-hospital to A&E handover. SOURCES OF EVIDENCE PubMed and CINAHL Complete databases. Grey literature. CHARTING METHODS the results are displayed in tables according to 'Title', 'Design', 'Country', 'Population', 'Concept', 'Context' and 'Results'. RESULTS 10 studies were included. The following themes emerged: communication and interpersonal issues, secondary risks, need for staff training, the use of structured methods, information technology support. CONCLUSIONS There is a gap in the literature. Issues regarding communication, differing ideas of what should be considered as priority, interpersonal relationships and trust between staff working for different services emerge. Connected with this there are structural problems such as shortage of suitable spaces and lack of staff training. The use of structured mnemonic methods, including computerized ones, seems to improve the quality of handovers, but to date it has not been possible to establish which method would be better than another. Further studies are recommended.
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Affiliation(s)
- Massimo Guasconi
- University of Parma, Department of Medicine and Surgery, Parma, Italy, “Azienda Unità Sanitaria Locale” (Local Health Service) of Piacenza, Piacenza, Italy
| | - Antonio Bonacaro
- University of Suffolk, School of Health and Sports Sciences, Ipswich, UK
| | - Emanuele Tamagnini
- “Croce Azzurra Riccione” (Local Emergency Medical Service), Riccione (RN), Italy
| | - Silvia Biral
- “Croce Azzurra Riccione” (Local Emergency Medical Service), Riccione (RN), Italy
| | - Linda Brigliadori
- “Azienda Unità Sanitaria Locale” (Local Health Service) Romagna, Rimini, Italy
| | - Sabrina Borioni
- “Azienda Sanitaria Unica Regionale” (Local Health Service) Marche, Fabriano (AN), Italy
| | - Daniele Collura
- “Azienda Socio Sanitaria Territoriale” (Local Health Service) of Crema, Crema (CR), Italy
| | | | - Giulia Ingallina
- “Azienda Unità Sanitaria Locale” (Local Health Service) of Piacenza, Piacenza, Italy
| | - Maria Chiara Bassi
- “Azienda Unità Sanitaria Locale – IRCCS” (Local Health Service) of Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Lucenti
- “Azienda Unità Sanitaria Locale” (Local Health Service) of Piacenza, Piacenza, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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Tortosa-Alted R, Martínez-Segura E, Berenguer-Poblet M, Reverté-Villarroya S. Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools. J Clin Med 2021; 10:5736. [PMID: 34945032 PMCID: PMC8707112 DOI: 10.3390/jcm10245736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
The emergency handover of critical patients is used to describe the moment when responsibility for the care of a patient is transferred from one critical patient care healthcare team to another, requiring the accurate delivery of information. However, the literature provides few validated assessment tools for the transfer of critical patients in urgent care and emergency settings. To identify the available evaluation tools that assess the handover of critical patients in urgent and emergency care settings in addition to evaluations of their psychometric properties, a systematic review was carried out using PubMed, Scopus, Cinahl, Web of Science (WoS), and PsycINFO, in accordance with PRISMA guidelines. The quality of the studies was assessed using the COSMIN checklist. Finally, eight articles were identified, of which only three included validated tools for evaluating the handover of critical patients in emergency care. Content validity, construct validity, and internal consistency were the most studied psychometric properties. Three studies evaluated error and reliability, criterion validity, hypothesis testing, and sensitivity. None of them considered cross-cultural adaptation or the translation process. This systematic psychometric review shows the existing ambiguities in the handover of critically ill patients and the scarcity of validated evaluation tools. For all of these reasons, we consider it necessary to further investigate urgent care and emergency handover settings through the design and validation of an assessment tool.
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Affiliation(s)
- Ruth Tortosa-Alted
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Spain; (R.T.-A.); (S.R.-V.)
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
| | - Estrella Martínez-Segura
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Spain; (R.T.-A.); (S.R.-V.)
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
| | - Marta Berenguer-Poblet
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
| | - Sílvia Reverté-Villarroya
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Spain; (R.T.-A.); (S.R.-V.)
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
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Tortosa-Alted R, Reverté-Villarroya S, Martínez-Segura E, López-Pablo C, Berenguer-Poblet M. Emergency handover of critical patients. A systematic review. Int Emerg Nurs 2021; 56:100997. [PMID: 33887611 DOI: 10.1016/j.ienj.2021.100997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emergency handover of critical patients is used to describe the moment of union between prehospital and hospital health team. However, the literature shows several definitions leading to great heterogeneity. PURPOSE To study the emergency handover of critical patients between two critical-emergency care wards performed by emergency nurses worldwide and to identify the features of these processes. METHODS We conducted an integrative review in eleven databases published from 2010 to 2019. Quality criteria and PRISMA checklist were applied. The protocol is registered with PROSPERO (CRD42020182335). RESULTS A total of 22 studies included and the following factors were identified: variability vs standardization, identification, professionals' behavior, localization, environmental factors, patient participation, clinical records, education/training, responsability, and communication. CONCLUSIONS The actual emergency handover occurs under conditions quite contrary to those recommended by experts so that it is neither safe nor effective, leading a serious problem for patient safety and quality care.
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Affiliation(s)
- Ruth Tortosa-Alted
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Tarragona, Spain; Nursing Department, Universitat Rovira Virgili, Campus Terres de l'Ebre, Avenue Remolins, 13-15, 43500 Tortosa, Tarragona, Spain.
| | - Sílvia Reverté-Villarroya
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Tarragona, Spain; Nursing Department, Universitat Rovira Virgili, Campus Terres de l'Ebre, Avenue Remolins, 13-15, 43500 Tortosa, Tarragona, Spain.
| | - Estrella Martínez-Segura
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Tarragona, Spain; Nursing Department, Universitat Rovira Virgili, Campus Terres de l'Ebre, Avenue Remolins, 13-15, 43500 Tortosa, Tarragona, Spain.
| | - Carlos López-Pablo
- Nursing Department, Universitat Rovira Virgili, Campus Terres de l'Ebre, Avenue Remolins, 13-15, 43500 Tortosa, Tarragona, Spain; Department of Pathology, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500, Tortosa, Tarragona, Spain.
| | - Marta Berenguer-Poblet
- Nursing Department, Universitat Rovira Virgili, Campus Terres de l'Ebre, Avenue Remolins, 13-15, 43500 Tortosa, Tarragona, Spain.
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Dal Pai D, Gemelli MP, Boufleuer E, Finckler PVPR, Miorin JD, Tavares JP, Cenci DC. Repercussões da pandemia pela COVID-19 no serviço pré-hospitalar de urgência e a saúde do trabalhador. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2021-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo conhecer repercussões da pandemia pela COVID-19 no trabalho e na saúde dos profissionais do Serviço de Atendimento Móvel de Urgência (SAMU) de uma capital da região Sul do Brasil. Métodos estudo qualitativo do tipo exploratório-descritivo, realizado com 55 trabalhadores de 16 equipes do SAMU, por meio de formulário eletrônico. Aplicou-se análise de conteúdo temática. Resultados foram identificadas as categorias: (1) mudanças percebidas frente a COVID-19: percebem aumento nas demandas assistenciais por agravos respiratórios, prejuízos nas relações com serviços da rede face aos novos protocolos e aumento do tempo resposta pela higienização das ambulâncias e paramentação/desparamentação; (2) dificuldades em relação aos Equipamentos de Proteção Individual (EPIs) e ao treinamento: sentem-se expostos ao risco de contaminação, preocupando-se com recursos de proteção; (3) os efeitos sociais e sobre a saúde dos trabalhadores: relataram sentimentos de medo e insegurança quanto à sua saúde e dos familiares, bem como as limitações do distanciamento social. Considerações finais e implicações para a prática a pandemia repercutiu sobre fluxos e rotinas laborais, bem como gerou novas necessidades acerca da precaução biológica e suporte emocional.
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Souza MMD, Xavier AC, Araújo CAR, Pereira ER, Duarte SDCM, Valladares Broca P. Communication between pre-hospital and intra-hospital emergency medical services: literature review. Rev Bras Enferm 2020; 73:e20190817. [PMID: 33338152 DOI: 10.1590/0034-7167-2019-0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/24/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze, according to the scientific literature, communication strategies in the transfer of cases between pre-hospital and in-hospital services and their contributions to patient safety. METHODS this is a literature review study, that is, one that aims to gather and synthesize research results on the subject in a systematic and orderly manner. RESULTS ten articles were published, published between 2010 and 2018, and two points of discussion emerged: use of mnemonics; and barriers to transferring a case. CONCLUSIONS studies point to the need to standardize the case transfer process, as well as integrative training of professionals, regular assessment of the teams involved in emergency medical services and the need for research on the subject.
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Affiliation(s)
| | - Allan Corrêa Xavier
- Universidade Federal do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Eric Rosa Pereira
- Fundação Técnico-Educacional Souza Marques. Rio de Janeiro, Rio de Janeiro, Brazil
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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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