The satisfaction regarding handovers between ambulance and emergency department nurses: an observational study

[Handover protocols in the emergency department]

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.

Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis

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.

Correlation between the quality of nursing handover, job satisfaction, and group cohesion among psychiatric nurses

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.

Handover methods between local emergency medical services and Accident and Emergency: is there a gold standard? A scoping review

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.

Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools

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.

Emergency handover of critical patients. A systematic review

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.

Repercussões da pandemia pela COVID-19 no serviço pré-hospitalar de urgência e a saúde do trabalhador

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.

Communication between pre-hospital and intra-hospital emergency medical services: literature review

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.

Impact of a Standardized Patient Hand-off Tool on Communication between Emergency Medical Services Personnel and Emergency Department Staff

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.

Barriers to effective EMS to emergency department information transfer at patient handover: A systematic review

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.