An Incomplete Medical Record: Transfer of Care From Emergency Medical Services to the Emergency Department

Abstract

Background: Transition of care from Emergency Medical Services (EMS) to the Emergency Department (ED) represents an intersection at high risk for error. Minimal research has quantitatively examined data transfer at this point. In Pennsylvania, this handoff consists of a transfer-of-care form (TOC) provided by EMS to ED in addition to a verbal report. A prehospital patient care report (PCR) is later filed by EMS up to 72 hours after concluding care.Objective: To evaluate the congruence between prehospital records provided at handoff and the final PCR found in the patient's medical record. Our hypothesis was that there would be discrepancies between the TOC and final PCR.Methods: A retrospective chart review was conducted comparing the TOC from a single EMS agency to the final PCR found in the electronic medical record. A convenience sample of 200 patients who received advanced life support transport over a one-month period were included. Metrics to assess the discrepancy between the reports included chief complaint, allergies, medications, systolic and diastolic blood pressure (SBP and DBP), pulse, respiratory rate (RR), Glasgow Coma Score (GCS), and prehospital treatment provided. The level of agreement between the two sources was compared using kappa statistics and concordance correlation coefficients (CCC) with 95% confidence intervals.Results: Of the 200 encounters that met inclusion criteria, 72% had matching chief complaints between the TOC and PCR. Medications matched in 66% and allergies matched in 82%. Up to three BP, pulse, and RR readings were collected; only 30% of the third BP readings were available from the TOC, while 68% were available from the PCR. Comparing the three SBP values on the TOC to respective counterparts on the PCR showed a substantial correlation (all CCC >0.95). Pulse and DBP values had moderate-to-substantial correlation (CCC: 0.93, 0.94, 0.96 and 0.77, 0.92, 0.94 respectively). RR showed inconsistent correlation (CCC: 0.37, 0.84, 0.94). GCS showed a moderate correlation between the two forms (CCC: 0.81).Conclusion: There were significant differences between the information transferred to the ED through the TOC compared to what was recorded in the PCR. Further evaluation of the TOC process is needed to improve accuracy.

Resident Physicians' Knowledge of Emergency Medical Services: A Comparison Between Emergency Medicine and Non-Emergency Medicine Resident Physicians

“…This may result in ineffective collaboration between physicians and EMS providers, leading to difficulties in developing shared treatment plans for patients. Furthermore, miscommunications between physicians and EMS providers could negatively impact patient safety; effective communication between EMS and emergency departments could potentially prevent patient harm [ 6 ].…”

Digitisation of emergency medicine: opportunities, examples and issues for consideration

“…For patients being sent from home to ED, further digital approaches can improve communication and safety, such as transmission of electronic records, vital signs or electrocardiograms of patients from pre-hospital services to ED. [ 14 15 16 17 ]…”

Cloud-Based Digital Twins’ Storage in Emergency Healthcare

“…between the two reports. In specific, numerical data such as heart rate and blood pressure were mismatched between TOC and PCR, and major data losses in both reports, with TOC missing around 40% more data than PCR [6]. This is concerning as TOC should be as precise as possible for urgent medical care.…”