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.