Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members

Abstract

Background Clinical handover between paramedics and the trauma team is undertaken in a time-pressured environment. Paramedics are often required to handover complex problems to a multitude of staff. There is evidence that information loss occurs at this transition. The aims of this project were to (1) develop a minimum dataset to assist paramedics provide handover; (2) identify attributes of effective and ineffective handover; (3) determine the feasibility of advanced data transmission; and (4) identify how to best display data in trauma bays. Methods Qualitative study of paramedics and trauma team members. A thematic analysis was undertaken using grounded theory. Results Ten paramedics and 17 trauma team members were interviewed. A minimum dataset modified on an existing template was developed to include fields required by the trauma team to inform immediate treatment. Respondents stated that an effective handover was one which was delivered succinctly and in a structured manner, and contained only vital data necessary to direct immediate treatment. Advanced transmission of data to the receiving hospital was widely supported. While computers carried by paramedics were capable of exporting data to the receiving hospital, barriers such as time constraints, workflow issues and infection control issues impeded the ability to do this in the current environment. Discussion There is support for the adoption and further evaluation of a handover template. It can provide valuable structure to the face-to-face handover, and experience from other specialties suggests it can reduce information loss. Strategies to enable information to be transmitted in advance of the patients' arrival must address concerns voiced by paramedics. BACKGROUND

Lost information during the handover of critically injured trauma patients: a mixed-methods study

“…Dealing with trainee trauma team leaders was also a source of stress, leading to increased chaos. While recent studies in trauma have also recognised challenges in handover in trauma (specifically from the field to the ED), these studies in general lack a deeper analysis of the role of system and culture in why this occurs, or solutions 16 28 29…”

“…This decrease in variability of the information transmitted reduces the amount of information loss,10 facilitates communication within the constraints of an 80 h work week14 and may lead to improved patient outcomes, including reduced mortality 15. Trauma patients, in particular, would benefit from a cohesive handover of information, given their complex presentations 16. Missed injuries in trauma patients remain associated with significant morbidity and mortality 17 18.…”

Clinical handovers between prehospital and hospital staff: literature review

“…Interviews with clinicians noted the importance attached to ‘clearly stated’ handovers,9 and the requirement that paramedics were ‘confident and succinct’,19 assertive and able to speak loudly 10. Effective handover was characterised by attentive receiving personnel9 who actively listened 19.…”

Design and trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO’

“…MIST appears to be the mnemonic of choice, but limited evidence supporting its use12 has meant that ambulance services have been hesitant to integrate MIST-based handover training into their curricula. Adding to concern is a study (albeit small) showing that training paramedics in the use of DeMIST (where ‘De’ stands for details: sex, approximate age, etc) led to paramedics' accuracy in conveying information to emergency clinicians (those receiving the information) being judged to have decreased 13.…”