Pre-hospital/emergency department handover in Italy

Abstract

In Italy, emergency department (ED) triage is a complex and delicate interface in which different emergency healthcare providers interact: physicians, nurses, and pre-hospital rescuers. There are significant differences in the communication, training, and abilities of these providers. Communication failures during the pre-hospital/hospital interface have been identified as a major preventable cause of patient harm. We previously evaluated handover in simulated scenarios, and developed specialized handover training for pre-hospital emergency rescuers. The purpose of this study is to evaluate communication during the clinical handover between pre-hospital to ED staff, using realistic scenarios. A nurse, trained through high-fidelity simulation handover scenarios, used our adapted ISBAR tool to evaluate inter-professional communication at triage. We evaluated and statistically analyzed 240 handovers performed by pre-hospital rescuers over nine observing shifts. On the whole, the data analysis highlights a lack of communication standards, a lack of formal transfer of responsibility of patient care, and a marked inconsistency in information communicated by every professional group examined. Only those rescuers who were previously trained in handover performed 100% of the ISBAR tool items. The information most often communicated was the reason for the call, (85%) and the information least often communicated was the complete ABCDE patient survey (1%). Currently, ED personnel receive poor verbal information from pre-hospital providers. The general habit of pre-hospital providers is to give different written reports to the triage nurses without a true shared transfer of responsibility. This lack of standardization in communication presumably has an adverse impact upon patient care.

Patient handover in the emergency department: ‘How’ is as important as ‘what’

“…Benefits of ideal patient handover, in which all of the patient's health care problems are clearly stated [6] provides direction to healthcare professionals to deliver safe [7], cost-effective quality patient care [8][9][10] and ultimately optimises patient outcomes [11]. Effective communication of relevant patient information in a structured and standardised format [12,13], includes active listening skills and patient involvement and participation [3,14].…”

“…In an emergency department (ED), patient handover occurs multiple times a day [7], including when patients are transferred to the ED by ambulance, from pre-hospital (emergency care practitioners) to in-hospital care (healthcare professionals). Emergency care practitioners have the knowledge and skill to deliver holistic care on a basic, intermediate and advanced level in the prehospital environment [17].…”

Handover of Patients From Prehospital Emergency Services to Emergency Departments

“…All of them found that using checklists reduces data loss and medical errors related to failures in communication, improves information content at handover and the quality and reliability of the information transmitted, and enhances clinical safety 13,14. Klim et al,15 in a survey and group discussion forum with ED nurses, identified that the information received, the past medical history, and vital signs of the patient were not checked for accuracy by most health care professionals, resulting in an inadequate and poor-quality handover 16. It is worthy of note that studies related to the transfer of patients between ambulance services and EDs are limited 10.…”

Am I getting an accurate picture: a tool to assess clinical handover in remote settings?

“…The literature describes a range of assessment tools that have been used to assess clinical handovers. Most hospital-based studies use tools that record how many specific pieces of information are handed over against an agreed list, including items included in frameworks such as ISBAR [ 10 – 15 ]. Other studies use a checklist to measure items related to effective clinical reasoning [ 16 ] or analyse patterns of handover communication [ 17 ].…”