Abstract
IntroductionThe handover process in the emergency department (ED) is relevant for patient outcomes and lays the foundation for adequate patient care. The aim of this study was to examine the current prehospital to ED handover practice with regard to content, structure, and scope.MethodsWe carried out a prospective, multicenter observational study using a specifically developed checklist. The steps of the handover process in the ED were documented in relation to qualification of the emergency medical services (EMS) staff, disease severity, injury patterns, and treatment priority.ResultsWe documented and evaluated 721 handovers based on the checklist. According to ISBAR (Identification, Situation, Background, Assessment, Recommendation), MIST (Mechanism, Injuries, Signs/Symptoms, Treatment), and BAUM (Situation [German: Bestand], Anamnesis, Examination [German: Untersuchung], Measures), almost all handovers showed a deficit in structure and scope (99.4%). The age of the patient was reported 339 times (47.0%) at the time of handover. The time of the emergency onset was reported in 272 cases (37.7%). The following vital signs were transferred more frequently for resuscitation room patients than for treatment room patients: blood pressure (BP)/(all comparisons p < 0.05), heart rate (HR), oxygen saturation (SpO2) and Glasgow Coma Scale (GCS). Physicians transmitted these vital signs more frequently than paramedics BP, HR, SpO2, and GCS. A handover with a complete ABCDE algorithm (Airway, Breathing, Circulation, Disability, Environment/Exposure) took place only 31 times (4.3%). There was a significant difference between the occupational groups (p < 0.05).ConclusionDespite many studies on handover standardization, there is a remarkable inconsistency in the transfer of information. A “hand-off bundle” must be created to standardize the handover process, consisting of a uniform mnemonic accompanied by education of staff, training, and an audit process.
Highlights
The handover process in the emergency department (ED) is relevant for patient outcomes and lays the foundation for adequate patient care
Despite many studies on handover standardization, there is a remarkable inconsistency in the transfer of information
A “hand-off bundle” must be created to standardize the handover process, consisting of a uniform mnemonic accompanied by education of staff, training, and an audit process. [West J Emerg Med. 2021;22(2)401–409.]
Summary
The handover process in the emergency department (ED) is relevant for patient outcomes and lays the foundation for adequate patient care. The aim of this study was to examine the current prehospital to ED handover practice with regard to content, structure, and scope. Medical handover from prehospital care to the emergency department (ED) is defined as the transfer of responsibility of the care of one or more patients to another person or team.[1,2] Handovers, especially in the ED, are of enormous significance for the subsequent emergency treatment because that treatment requires precise timing, rapid decision-making, and specific expertise.[2,3] the handover is critical for the relaying of information, such as interventions that have occurred and details from the emergency scene. The transfer from prehospital care to the ED is always an interprofessional process involving at least two professional groups. Handover in the ED: Discrepancy Between Theory and Practice lead to misunderstandings and dissatisfaction due to different expectations and approaches.[2,4,5,6]
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