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Abstract

Introduction: Preventable deaths due to error in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in Level I trauma centers. The root cause of 67% of the Joint Commission sentinel events is communication errors, including those generated during the handover of patient information between in-hospital units. Hypothesis: The objective was to identify challenges in the handover of trauma patients from the Emergency Department (ED) to the Intensive Care Unit (ICU) from the perspective of Trauma Team Leaders (TTLs) in a Canadian Level I Trauma Center. Methods: Qualitative, semi-structured interviews were conducted with multi-disciplinary TTLs exploring themes related to the structure, process and outcome of handover. Thematic analysis was undertaken using Grounded Theory methodology. Results: Recurrent themes emerged demonstrating challenges in the handover of the trauma patient from the ED to the ICU. Specifically, handover lacked a standardized structure. Responsibility for handover initiation was poorly defined. The process was also felt to be haphazard with multiple distracting forces. These included absentee receiving personnel to parallel handovers performed in a noisy environment. Outcomes were felt to be worse for patient safety as critical, clinical information was lost with the lack of a standardized structure for handover. Multi-disciplinary TTLs placed different importance on specific clinical details during handover. Standardization processes analogous to the ‘surgical safety checklist’ were welcomed as potential solutions. Conclusions: The handover of clinical information of critically injured trauma patients is complex and lacks standardization. Checklists should be utilized as a quality improvement tool to improve communication between the ED and ICU teams during trauma patient handover.