Board 259 Program Innovations Abstract A Novel Simulation Program to Train Paramedic Students in Safe EMS Patient Handoff (Submission #411)

Abstract

Introduction/Background Emergency medical services (EMS) patient handoffs are a critical step in patient care and safety. Approximately 28 million such handoffs occur every year in the United States.1 Despite the importance of safe handoff to patient care, very little exists in formally accredited EMS or paramedic science education regarding the appropriate information to convey to hospital based patient care teams. While the effective use of simulation in paramedic education has been previously described,2,3 the essential step of patient handoff has been largely ignored. We developed and successfully implemented an interprofessional simulation program focused on safe patient handoff. Methods A focus group of emergency medicine faculty, nursing faculty and paramedic science educators came together to develop a program for teaching paramedic science students safe and effective handoffs. The selected educational tool for patient handoff was previously validated and contains the following information: Identification, Mechanism/medical complaint, Injuries/information relative to complaint, Signs/vitals including GCS, Treatment and trends, Allergies, Medications, Background history, and Other (IMIST-AMBO).4 Paramedic students received a didactic session on IMIST-AMBO and were then brought to the simulation center to practice communication and other patient management skills. The simulation began in the center’s Transport Room, featuring a decommissioned ambulance with a manikin representing a patient who had been in a high speed motor vehicle collision. After receiving initial “on scene” information from a confederate first-responder, teams of two paramedic students assumed care of the manikin for a 10 minute transport period. Upon arrival at the hospital, the students had to successfully unload the patient and transport him down the hall to a simulated emergency department room. Emergency medicine residents and nursing students, who until that point were blind to the use of paramedic students, were waiting in the room. The paramedic students transferred care to the team, communicating what they believed was pertinent information. The remainder of the case was completed with paramedic students providing additional assistance to the emergency department team. Following each case a structured debrief session was conducted featuring all members of the patient care team. The debriefing focused on communication issues as part of the patient handoff. All participants completed pre-session and post-session surveys regarding attitudes toward interprofessional communication and overall satisfaction with the simulation. Results: Conclusion A total of 12 paramedic students, 19 emergency medicine residents and 16 nursing students participated in the simulation. In the post-session survey, 44/47 participants (93.6%) agreed or strongly agreed that the in room experience was valuable for preparing them to work with other healthcare providers and 43/47 participants (91.5%) agreed or strongly agreed that the debriefing was valuable. Importantly, 44/47 participants (93.6%) agreed or strongly agreed that the experience enhanced their understanding of the importance of “clear, concise, and respectful” communication during paramedic-physician handoffs. Amongst the primary target audience of paramedic students, 100% agreed or strongly agreed with that statement. In open-ended feedback, paramedic students described the experience as “very beneficial” and noted that it seemed realistic. This model demonstrates an effective educational method for teaching safe patient handoff. Further studies more accurately quantifying the educational benefit will likely follow and have the potential to impact paramedic science education at other institutions. With the clear importance of safe and effective handoff in overall patient care, this could benefit our patients. Furthermore, safe patient transitions are not limited to paramedic-physician handoff in the emergency department and this simulation-based educational model could be easily adapted to provide training for multiple healthcare providers.