We carried out a prospective, multicenter observational study using a specifically developed checklist. The steps of the handover process in the ED were documented in relation to qualification of the emergency medical services (EMS) staff, disease severity, injury patterns, and treatment priority. Results: We documented and evaluated 721 handovers based on the checklist. According to ISBAR (Identification, Situation, Background, Assessment, Recommendation), MIST (Mechanism, Injuries, Signs/Symptoms, Treatment), and BAUM (Situation [German: Bestand], Anamnesis, Examination [German: Untersuchung], Measures), almost all handovers showed a deficit in structure and scope (99.4%). The age of the patient was reported 339 times (47.0%) at the time of handover. The time of the emergency onset was reported in 272 cases (37.7%). The following vital signs were transferred more frequently for resuscitation room patients than for treatment room patients: blood pressure (BP)/(all comparisons p < 0.05), heart rate (HR), oxygen saturation (SpO 2) and Glasgow Coma Scale (GCS). Physicians transmitted these vital signs more frequently than paramedics BP, HR, SpO 2 , and GCS. A handover with a complete ABCDE algorithm (Airway, Breathing, Circulation, Disability, Environment/Exposure) took place only 31 times (4.3%). There was a significant difference between the occupational groups (p < 0.05). Conclusion: Despite many studies on handover standardization, there is a remarkable inconsistency in the transfer of information. A "hand-off bundle" must be created to standardize the handover process, consisting of a uniform mnemonic accompanied by education of staff, training, and an audit process. [West J Emerg Med. 2021;22(2)401-409.] that treatment requires precise timing, rapid decision-making, and specific expertise. 2,3 Furthermore, the handover is critical for the relaying of information, such as interventions that have occurred and details from the emergency scene. The transfer from prehospital care to the ED is always an interprofessional process involving at least two professional groups. This can
Background The presentational flow chart “unwell adult” of the Manchester Triage System (MTS) occupies a special role in this triage system, defined as the nonspecific presentation of an emergency patient. Current scientific studies show that a considerable proportion of emergency room patients present with so-called "nonspecific complaints". The aim of the present study is to investigate in detail the initial assessment of emergency patients triaged according to the presentational flow chart "unwell adult". Methods Monocentric, retrospective observational study. Results Data on 14,636 emergency department visits between March 12th and August 12th, 2019 were included. During the observation period, the presentational flow chart "unwell adult" was used 1,143 times and it was the third most frequently used presentational flow chart. Patients triaged with this flow chart often had unspecific complaints upon admission to the emergency department. Patients triaged with the “unwell adult” chart were often classified with a lower triage level. Notably, patients who died in hospital during the observation period frequently received low triage levels. The AUC for the MTS flow chart “unwell adult” and hospitalization in general for older patients (age ≥ 65 years) was 0.639 (95% CI 0.578–0.701), and 0.730 (95% CI 0.714–0.746) in patients triaged with more specific charts. The AUC for the MTS flow chart “unwell adult” and admission to ICU for older patients (age ≥65 years) was 0.631 (95% CI 0.547–0.715) and 0.807 (95% CI 0.790–0.824) for patients triaged with more specific flow charts. Comparison of the predictive ability of the MTS for in-hospital mortality in the group triaged with the presentational flow chart “unwell adult” revealed an AUC of 0.682 (95% CI 0.595–0.769) vs. 0.834 (95% CI 0.799–0.869) in the other presentational flow charts. Conclusion The presentational flow chart "unwell adult" is frequently used by triage nurses for initial assessment of patients. Patient characteristics assessed with the presentational flow chart "unwell adult" differ significantly from those assessed with MTS presentational flow charts for more specific symptoms. The quality of the initial assessment in terms of a well-functioning triage priority assessment tool is less accurate than the performance of the MTS described in the literature.
Zusammenfassung Hintergrund Die Weitergabe von Informationen in einer stressbesetzten, hoch dynamischen Arbeitsumgebung wie der zentralen Notaufnahme (ZNA) stellt eine Risikoquelle für die Entstehung von Behandlungsfehlern dar und ist somit mortalitätsbeeinflussend. Ziel der Arbeit In der Arbeit wird untersucht, welchen Stellenwert dem Übergabeprozess durch die beteiligten Berufsgruppen beigemessen wird und welche strukturellen Merkmale bzw. Rahmenbedingungen dem Übergabeprozess von diesen zugeschrieben werden. Material und Methoden Bei der vorliegenden Studie handelte es sich um eine anonyme, freiwillige, webbasierte (Online‑)Umfrage, die mittels eines strukturierten elektronischen Fragebogens durchgeführt wurde. Ergebnisse Insgesamt haben 2728 Teilnehmer an der Onlineumfrage teilgenommen. Nahezu alle Teilnehmer-/innen benennen die Übergabe als outcomerelevanten Parameter für die Patienten, allerdings sehen 3 von 4 Teilnehmern den Übergabeprozess als verbesserungswürdig an. Bei der Selbsteinschätzung meinen 4 von 5 Teilnehmer-/innen, die Übergabe zu beherrschen. Es lässt sich unter den Teilnehmern kein favorisiertes Übergabeschema erkennen, die Mehrheit benutzt entweder ein eigenes oder gar kein Übergabeschema. Eine hohe Übereinstimmung zwischen Rettungsdienst und ZNA-Mitarbeitern liegt in Bezug auf Kerninhalte und Rahmenbedingungen der Übergabe vor. Mit großer Mehrheit zeigt sich der Wunsch nach einem einheitlichen Übergabeschema sowie nach Integrierung in Aus- und Fortbildungskonzepte. Diskussion Als Konsequenz der Umfrage sollte zügig auf nationaler Ebene mit allen an der Übergabe beteiligten Strukturen ein standardisiertes Übergabeverfahren etabliert werden. Die Bereitstellung entsprechender finanzieller und personeller Ressourcen für die Umsetzung dieses gesundheitspolitischen Ziels ist allerdings Voraussetzung.
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