Clinical handovers between prehospital and hospital staff: literature review

Wood, Kate; Crouch, Robert; Rowland, Emma; Pope, Catherine

doi:10.1136/emermed-2013-203165

Cited by 68 publications

(63 citation statements)

References 39 publications

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“…Good handover has been shown to be associated with improvements in patient safety, continuity of patient care, and improved decision making. [1]Prehospital to hospital transition of care most frequently occurs between paramedics and emergency triage nurses. A verbal report is typically provided by paramedics and documented by triage nurses.…”

Section: Problemmentioning

confidence: 99%

Availability of ambulance patient care reports in the emergency department

Shelton

Sinclair

2016

BMJ Qual Improv Report

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Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses.Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts.A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports.Improvement strategies consisted of:1. Educating ED clerical staff about the importance of EMS reports2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of EMS reports.Implementation of change strategies did not result in a significant improvement in the percentage of EMS reports available to emergency physicians at the time of initial patient assessment. However, tracking both external and internal processes that influence EMS report availability showed the internal process time from fax report receipt to distribution significantly improved. This improvement reflected the change strategies that were all directed at improving the internal process.EMS patient care reports are more efficiently processed and distributed in the ED due to change strategies implemented that targeted the ED's internal process of EMS report distribution. The external process responsible for transmitting EMS reports to the ED is the limiting factor that prevents consistent timely access of EMS reports by emergency physicians and will require dedicated improvement strategies.

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Section: Problemmentioning

confidence: 99%

Availability of ambulance patient care reports in the emergency department

Shelton

Sinclair

2016

BMJ Qual Improv Report

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“…In EMS teams, poor communication during hando s (for instance, the transfer of patient care from one EMS team member to another) accounts for nearly 70 percent of mistakes that occur. 25 On the other hand, when handled correctly, hando s can improve patient safety by facilitating information sharing and decision making across team personnel shi s. 26 In CSIRTs, many cyber-incident handling errors occur during hando s. 27 EMS teams have developed several methods to improve the quality of hando s. Foremost among these are the use of mnemonics designed to prompt the two parties to exchange all appropriate information clearly and concisely. 28 For example, the mnemonics SBAR (situation, background, assessment, and recommendation) and SHARED (situation, history, assessment, risks, events, and documentation) are used in emergency situations due to their e ectiveness in conveying relevant information.…”

Section: Enhance Communication Among Csirt Membersmentioning

confidence: 99%

Improving Cybersecurity Incident Response Team Effectiveness Using Teams-Based Research

Steinke

Bolunmez

Fletcher

et al. 2015

IEEE Secur. Privacy

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“…Yet, signout communication is equally important in the prehospital setting where multiple factors influence patient signout. Signout improvement requires a multidisciplinary approach viewing the processes as social, contextual, and organizationalbehavior issues [10][11][12][13]. A common language and understanding between prehospital and hospital care providers is essential to successful communication and quality patient care [12,14].…”

Section: Introductionmentioning

confidence: 99%

Critical Communication: A Cross-sectional Study of Signout at the Prehospital and Hospital Interface

Janagama

Strehlow

Gimkala

et al. 2020

Cureus

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Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low-and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7 to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%) and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication.

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Clinical handovers between prehospital and hospital staff: literature review

Cited by 68 publications

References 39 publications

Availability of ambulance patient care reports in the emergency department

Availability of ambulance patient care reports in the emergency department

Improving Cybersecurity Incident Response Team Effectiveness Using Teams-Based Research

Critical Communication: A Cross-sectional Study of Signout at the Prehospital and Hospital Interface

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