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Farhat H, Makhlouf A, Gangaram P, Aifa KE, Khenissi MC, Howland I, Abid C, Jones A, Howard I, Castle N, Al Shaikh L, Khadhraoui M, Gargouri I, Laughton J, Alinier G. Exploring factors influencing time from dispatch to unit availability according to the transport decision in the pre-hospital setting: an exploratory study. BMC Emerg Med 2024; 24:77. [PMID: 38684980 PMCID: PMC11057082 DOI: 10.1186/s12873-024-00992-1] [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: 01/17/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Efficient resource distribution is important. Despite extensive research on response timings within ambulance services, nuances of time from unit dispatch to becoming available still need to be explored. This study aimed to identify the determinants of the duration between ambulance dispatch and readiness to respond to the next case according to the patients' transport decisions. METHODS Time from ambulance dispatch to availability (TDA) analysis according to the patients' transport decision (Transport versus Non-Transport) was conducted using R-Studio™ for a data set of 93,712 emergency calls managed by a Middle Eastern ambulance service from January to May 2023. Log-transformed Hazard Ratios (HR) were examined across diverse parameters. A Cox regression model was utilised to determine the influence of variables on TDA. Kaplan-Meier curves discerned potential variances in the time elapsed for both cohorts based on demographics and clinical indicators. A competing risk analysis assessed the probabilities of distinct outcomes occurring. RESULTS The median duration of elapsed TDA was 173 min for the transported patients and 73 min for those not transported. The HR unveiled Significant associations in various demographic variables. The Kaplan-Meier curves revealed variances in TDA across different nationalities and age categories. In the competing risk analysis, the 'Not Transported' group demonstrated a higher incidence of prolonged TDA than the 'Transported' group at specified time points. CONCLUSIONS Exploring TDA offers a novel perspective on ambulance services' efficiency. Though promising, the findings necessitate further exploration across diverse settings, ensuring broader applicability. Future research should consider a comprehensive range of variables to fully harness the utility of this period as a metric for healthcare excellence.
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Affiliation(s)
- Hassan Farhat
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
- Faculty of Sciences, University of Sfax, 3000, Sfax, Tunisia.
- Faculty of Medicine 'Ibn El Jazzar', University of Sousse, 4000, Sousse, Tunisia.
| | - Ahmed Makhlouf
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- College of Engineering, Qatar University, Doha, Qatar
| | - Padarath Gangaram
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Faculty of Health Sciences, Durban University of Technology, PO Box 1334, Durban, 4000, South Africa
| | - Kawther El Aifa
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | | | - Ian Howland
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Cyrine Abid
- Laboratory of Screening Cellular and Molecular Process, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Andre Jones
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ian Howard
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Nicholas Castle
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Loua Al Shaikh
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Moncef Khadhraoui
- Higher Institute of Biotechnology, University of Sfax, Sfax, Tunisia
| | - Imed Gargouri
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - James Laughton
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Guillaume Alinier
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- University of Hertfordshire, Hatfield, UK
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Northumbria University, Newcastle Upon Tyne, UK
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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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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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Araujo AF, Pereira ER, Duarte SDCM, Broca PV. Pre-hospital assistance by ambulance in the context of coronavirus infections. Rev Bras Enferm 2021; 74Suppl 1:e20200657. [PMID: 33605363 DOI: 10.1590/0034-7167-2020-0657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. METHOD A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. RESULTS To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. FINAL CONSIDERATIONS The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.
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Affiliation(s)
| | - Eric Rosa Pereira
- Centro Universitário UNIABEU. Belford Roxo, Rio de Janeiro, Brazil.,Fundação Técnico-Educacional Souza Marques. Rio de Janeiro, Rio de Janeiro, Brazil
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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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Lindquist BD, Koval KW, Acker PC, Bills CB, Khan A, Zachariah S, Newberry JA, Rao GVR, Mahadevan SV, Strehlow MC. Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept. Open Access Emerg Med 2020; 12:201-210. [PMID: 32982494 PMCID: PMC7505709 DOI: 10.2147/oaem.s249447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India. METHODS From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide). LESSONS LEARNED During the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials. CONCLUSION These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.
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Affiliation(s)
- Benjamin D Lindquist
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Kathryn W Koval
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC29425, USA
| | - Peter C Acker
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Corey B Bills
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
- University of California San Francisco, San Francisco, CA94143, USA
| | - Ayesha Khan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Sybil Zachariah
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - G V Ramana Rao
- GVK Emergency Management and Research Institute, Secunderabad, Telangana500078, India
| | - Swaminatha V Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
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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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Holt N, Crowe K, Lynagh D, Hutcheson Z. Is there a need for formal undergraduate patient handover training and could an educational workshop effectively provide this? A proof-of-concept study in a Scottish Medical School. BMJ Open 2020; 10:e034468. [PMID: 32051318 PMCID: PMC7045128 DOI: 10.1136/bmjopen-2019-034468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Poor communication between healthcare professionals is recognised as accounting for a significant proportion of adverse patient outcomes. In the UK, the General Medical Council emphasises effective handover (handoff) as an essential outcome for medical graduates. Despite this, a significant proportion of medical schools do not teach the skill. OBJECTIVES This study had two aims: (1) demonstrate a need for formal handover training through assessing the pre-existing knowledge, skills and attitudes of medical students and (2) study the effectiveness of a pilot educational handover workshop on improving confidence and competence in structured handover skills. DESIGN Students underwent an Objective Structured Clinical Examination style handover competency assessment before and after attending a handover workshop underpinned by educational theory. Participants also completed questionnaires before and after the workshop. The tool used to measure competency was developed through a modified Delphi process. SETTING Medical education departments within National Health Service (NHS) Lanarkshire hospitals. PARTICIPANTS Forty-two undergraduate medical students rotating through their medical and surgical placements within NHS Lanarkshire enrolled in the study. Forty-one students completed all aspects. MAIN OUTCOME MEASURES Paired questionnaires, preworkshop and postworkshop, ascertained prior teaching and confidence in handover skills. The questionnaires also elicited the student's views on the importance of handover and the potential effects on patient safety. The assessment tool measured competency over 12 domains. RESULTS Eighty-three per cent of participants reported no previous handover teaching. There was a significant improvement, p<0.0001, in confidence in delivering handovers after attending the workshop. Student performance in the handover competency assessment showed a significant improvement (p<0.05) in 10 out of the 12 measured handover competency domains. CONCLUSIONS A simple, robust and reproducible intervention, underpinned by medical education theory, can significantly improve competence and confidence in medical handover. Further research is required to assess long-term outcomes as student's transition from undergraduate to postgraduate training.
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Affiliation(s)
- Nicholas Holt
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
| | - Kirsty Crowe
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
| | - Daniel Lynagh
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
| | - Zoe Hutcheson
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
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Fitzpatrick D, McKenna M, Duncan EAS, Laird C, Lyon R, Corfield A. Critcomms: a national cross-sectional questionnaire based study to investigate prehospital handover practices between ambulance clinicians and specialist prehospital teams in Scotland. Scand J Trauma Resusc Emerg Med 2018; 26:45. [PMID: 29859121 PMCID: PMC5984735 DOI: 10.1186/s13049-018-0512-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Improving the accuracy and quality of handover may reduce associated mortality and morbidity. Although the practice of handover between Ambulance and Emergency Department clinicians has received some attention over recent years there is little evidence to support handover best practice within the prehospital domain. Further research is therefore urgently required to understand the most appropriate way to deliver clinical information exchange in the pre-hospital environment. We aimed to investigate current clinical information exchange practices, perceived challenges and the preferred handover mnemonic for use during transfer of high acuity patients between ambulance clinicians and specialist prehospital teams. METHODS A national, cross-sectional questionnaire study. Participants were road based ambulance clinicians (RBAC) or active members of specialist prehospital teams (SPHT) based in Scotland. RESULTS Over a three month study period there were 247 prehospital incidents involving specialist teams. One hundred ninety individuals completed the questionnaire; 61% [n = 116] RBAC and 39% [n = 74] SPHT. Median length of prehospital experience was 10 years (IQR 5-18). Overall current prehospital handover practices were perceived as being effective (Mdn 4.00; IQR 3-4 [1 = very ineffective - 5 = very effective]) although SPHT clinicians rated handover effectiveness slightly lower than RBAC's (Mdn 3.00 vs 4.00, U = 1842.5, p = .03). 'ATMIST' (Age, Time of onset, Medical complaint/injury, Investigation, Signs and Treatment) was deemed the mnemonic of choice. The clinical variables perceived as essential for handover are not explicitly identified within the SBAR mnemonic. The most frequently reported method of recording and transferring information during handover was via memory (n = 112 and n = 120 respectively) and 'interruptions' were perceived as the most significant barrier to effective handover. CONCLUSION While, overall, current prehospital handover practice is perceived as effective this study has identified a number of areas for improvement. These include the development of a shared mental model through system standardisation, innovations to support information recording and delivery, and the clear identification at incidents of a handover lead. Mnemonics must be carefully selected to ensure they explicitly contain the perceived essential clinical variables required for prehospital handover; the mnemonic ATMIST meets these requirements. New theoretically informed, evidence-based interventions, must be developed and tested within existing systems of care to minimise information loss and risk to patients.
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Affiliation(s)
- David Fitzpatrick
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA Stirling, Scotland
| | - Michael McKenna
- Scottish Ambulance Service, Glebe Cottage, Strath, Gairloch, Ross-shire IV212BT Scotland
| | - Edward A. S. Duncan
- Nursing, Midwifery & Allied Health Professions Research Unit, University of Stirling, FK9 4NF Scion House, Scotland, UK
| | - Colville Laird
- Basics Scotland, Aberuthven Enterpise Park, Sandpiper House, Aberuthven, Auchterarder Scotland
| | - Richard Lyon
- Pre-Hospital Emergency Care, School of Health Sciences, University of Surrey, Guildford, UK
| | - Alasdair Corfield
- Emergency Medical Retrieval Service, School of Medicine, Dentistry and Nursing, University of Glasgow, Wolfson Medical School Building, G12 8QQ Glasgow, Scotland
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Patient handover in the emergency department: ‘How’ is as important as ‘what’. Int Emerg Nurs 2018; 36:46-50. [DOI: 10.1016/j.ienj.2017.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 11/20/2022]
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