Abstract
BackgroundPoor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality.MethodsThis study aimed to measure the feasibility and acceptability of a novel, low tech intervention, designed to support clinical information recording and delivery during pre-alert and handover within the pre-hospital and ED setting. A simple pre and post-test design was used with a historical control. Eligible participants included all ambulance clinicians based at one large city Ambulance Station (n = 69) and all nursing and physician staff (n = 99) based in a city Emergency Department.ResultsTwenty five (36%) ambulance clinicians responded to the follow-up survey. Most felt both the pre-alert and handover components of the card were either ‘useful-very useful’ (n = 23 (92%); and n = 18 (72%) respectively. Nineteen (76%) used the card to record clinical information and almost all (n = 23 (92%) felt it ‘useful’ to ‘very useful’ in supporting pre-alert. Similarly, 65% (n = 16) stated they ‘often’ or ‘always’ used the card to support handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables. Results from the post-test survey measuring ED staff (n = 37) perceptions of handover demonstrated small (p < 0.05) improvements in handover in 3/5 domains measured.ConclusionThis novel low-tech intervention was highly acceptable to ambulance clinician participants, improving their data recording and information exchange processes. However, further well conducted studies are required to test the impact of this intervention on information exchange during pre-alert and handover.
Highlights
Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths
During the 3 month study period ambulance clinicians at the intervention station responded to 5339 call and conveyed 1938 (30%) of these patients to the participating Emergency Department (ED)
There were approximately 160 (20/week) pre-alerts made to the ED during this time period
Summary
Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Handover of critically ill or injured patients from the pre-hospital to Emergency Department (ED) team carries additional risk due to the time critical nature of the process and multiple human factors involved in dealing with stressful clinical events [5, 8]. Despite the limited evidence on pre-hospital to ED handover practice, a number of pragmatic options, informed by theory, have been recommended These include for example, the development of shared mental models, standardisation of approach (an agreed handover system and format/mnemonic) applied at the interface between professional domains, and the introduction of technology to support and enhance the process [5, 7, 11].
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