Handover In Emergency Department Research Articles

How to make emergency department handovers more effective

Ambulance crews and emergency department nurses work in an increasingly pressurised environment and handovers of patient information are key, here are tools and techniques to help

Assessing the quality of patient handovers between ambulance services and emergency department \u2013 development and validation of the emergency department human factors in handover tool

BackgroundPatient handover between prehospital care and the emergency department plays a key role in patient safety. Therefore, we aimed to create a validated tool for measuring quality of communication and interprofessional relations during handover in this specific setting.MethodsBased on a theoretical framework a comprehensive item pool on information transfer and human factors in emergency department handovers was created and refined in a modified Delphi survey involving clinical experts. Based on a pre-test, items were again revised. The resulting Emergency Department Human Factors in Handover tool (ED-HFH) was validated in a field test at the emergency department of a German university hospital from July to December 2017. The ED-HFH was completed by emergency department and ambulance service staff participating in handovers and by an external observer. Description of item characteristics, exploratory factor analysis, analyses on internal consistency and interrater reliability by intraclass-correlation. Construct validity was analysed by correlation with an overall rating on quality of the handover.ResultsThe draft of the ED-HFH contained 24 items, 90 of 102 eligible staff members participated in the field test completing 133 questionnaires on 38 observed handovers. Four items were deleted after analysis of item characteristics. Factor analysis supported a single factor explaining 39% of variance in the items. Therefore, a sum-score was calculated with a possible range between 14 and 70. The median value of the sum-score in the sample was 61.5, Cronbach’s α was 0.83, intraclass-correlation was 0.52, the correlation with the overall rating of hand-over quality was ρ = 0.83 (p ≤ 0.001).ConclusionsThe ED-HFH showed its feasibility, reliability and validity as a measure of quality of information transfer and human factors in handovers between ambulance services and the emergency department. It promises to be a useful tool for quality assurance and staff training.

Nursing communication handover in emergency department

Introduction Effective communication in the transition of care is fundamental to improve patient safety and contribute to the reduction of adverse events [1]. A study carried out in 2014, in fifty-five hospital units in Portugal, under the “Evaluation of Patient Safety Culture in Hospitals”, concluded that patient safety culture is not yet widely acknowledged as a priority for health professionals [2], and that 70% of adverse health events occur due to communication failures among health professionals during the transition of care. Ineffective communication can be found in different health contexts, being more frequent during the transition of care, when it is essential to manage situations quickly and effectively. The peri-operative period, the ICU and emergency department are examples of contexts where communication processes are complex and prone to errors. Objective To know nurses opinion about the transition of care in the emergency department, as well as their knowledge on the patient safety. Materials and Methods This is a descriptive and exploratory study with a quantitative approach. Non-probabilistic and convenience sample. This study intends to answer the following research questions: What is the opinion of the emergency department nurses about the time of transition of care during shift change? Do nurses know the guidelines for patient safety in the care transition? A questionnaire was used as a data collection instrument. It consists of three parts: a first part on sample characterisation; a second part that seeks to know the opinion of nurses about the transition of care in the change of shift; and a third part, with the objective of assessing nurses' knowledge on patient's safety. The questionnaire was applied during the month of January 2019. Results Of the total of seventy questionnaires delivered fifty were returned, with a response rate of 67.57%. The sample is essentially composed of women (82%), with a mean age of 33.46 years. They have on average 10.67 years as nurses and 7.29 years as nurses in the emergency department. With regard to nurses' opinion on the transition of care during shift change, four domains were found, namely: Positive aspects of the nursing care transition moment; Negative aspects of the nursing care transition moment; Patient evaluation at the moment of nursing care transition; and management of the information obtained during the nursing care transition. Regarding nurses' knowledge on patient safety, three areas were identified: Knowledge of the guidelines on effective communication in the transition of care; Benefits of using a standard tool in the transition of care, and training in the area of patient safety. Discussion and conclusions: Nurses feel that there are a number of factors that interfere with the transition of care; there is irrelevant information that is transmitted in the moment of transition of care and the ISBAR methodology contributes to decision-making and critical thinking. It is important to promote team training in the area of patient safety. Nurses have the legal obligation to ensure continuity of care through effective communication, using existing resources, namely the ISBAR tool.

Prospective Observational Multisite Study of Handover in the Emergency Department: Theory versus Practice.

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.

Improving pressure ulcer risk identification: a pilot project by ambulance staff

Background: A quality improvement initiative was designed to identify patients at risk of compromised tissue viability before they were admitted to hospital. Paramedics were educated to better identify patients with pressure ulcers or pressure damage, or those at risk of compromised tissue viability, and these patients were fitted with a pressure ulcer alert bracelet so that emergency department staff could identify them. Aims: The aims of the current initiative were to educate paramedics to better identify patients with pressure ulcers or those at risk of compromised tissue viability to emergency department staff, and fit them with a pressure ulcer alert bracelet to highlight them to emergency department staff so they would receive prompt intervention. Methods: A plan, do, study, act improvement methodology was used, and data from a 3-month period were retrospectively analysed. Patients identified as being at risk of compromised tissue viability were flagged as requiring assessment via a pressure ulcer risk assessment tool to enable prevention. Results: Paramedics identified 130 at-risk patients (aged 23–100 years), and data from 127 patients were analysed. Most at-risk patients fitted with pressure ulcer alert bracelets were aged 70 years or over, and there was an even female/male division. More than half (53%) of patients were found to have a pressure ulcer and alerted to emergency department staff. More than one in four (27%) patients who were identified as being at risk of pressure ulcers lived in nursing or residential homes, and 43% lived alone or in warden-controlled accommodation. Conclusions: Paramedics effectively identified potential risk factors for pressure ulcer development, indicating a need for immediate intervention. This study gives insight into how pressure ulcer risk assessment using an alert bracelet may be used in paramedic practice in emergency department handovers. Success depends on hospital staff acting upon paramedic recommendation.

Development and implementation of a standardised emergency department intershift handover tool to improve physician communication

BackgroundStructured handover can reduce communication breakdowns and potential medical errors. In our emergency department (ED) we identified a safety risk due to variation in quality and content of overnight handovers...

The Role of Quality Control Circles in Sustained Improment of Nurses, Handover in Emergency Department

The Role of Quality Control Circles in Sustained Improment of Nurses, Handover in Emergency Department

The application of checklist for nursing handover in emergency department

Objective To explore the effects of checklist for nursing handover in emergency department. Methods A total of 48 emergency department nurses were recruited by convenient sampling method. We implemented nursing bedside handover checklist four months, the quality of the nursing handover and nurses′ mastery of the patients′ condition and the patients′ satisfaction were compared before and after the implementation. Results After four-month intervention, the score of the nursing handover quality increased from 60.39±3.22 to 67.73±3.09, the difference was statistically significant (t=-14.377, P<0.01). The score of the nurses′ mastery of the patients′ condition increased from 23.89±2.34 to 27.08±1.82, and there was significant difference (t=-7.287, P<0.01). Patients′ satisfaction improved from 91.163% (111/121) to 96.67% (116/120), the difference was statistically significant (χ2=10.66, P<0.05). Conclusions Implementation of nursing bedside-handover checklist in emergency department can reduce individual cognitive defects, decrease the information missing of the nursing handover,improve the quality of nursing work and ensure the safety of patients. Key words: Checklist; Emergency department; Nursing handover

Evaluation of Intershift Handover in Emergency Department

Objective: Intershift handover (IH) in emergency departments can lead to serious distress in terms of both patient and doctor safety. In the study; it was aimed to determine how patients handed over between the shifts in the emergency services and the deficiencies, defects and errors occurred during this process. Methods: This study was conducted with 462 emergency doctors at 62 private, state, training research and university hospitals in Istanbul, Edirne, Kirklareli and Tekirdag cities where almost one fourth of Turkish population live, by interwiewing face-to-face between April 2016 and June 2016. Results: There were statistically significant difference between the groups who said that the transfer quality depends on the transferer doctor and lecturer and the other groups (respectively p<0.05). 98.1% (n = 453) of the physicians stated that they completely or partially agree with that; the deficiencies during handover the effect negatively the treatment of the patient (p<0.05). Conclusion: In conclusion, it is obvious that; the intershift handover in emergency department is vital. By reducing the number of mistakes made during this period, the quality of treatment of patients can be increased. In order to achieve this, we also think that it would be beneficial to give education to emergency service doctors about patient handover and to use a standardized intershift patient handover form.

LO25: The development and implementation of a standardized emergency department handover tool

Introduction: There is a high risk for communication breakdown, discontinuity of clinical care, and medical errors during ED physician handover. Locally, there is no standardized handover process to ensure adequate communication of critical information. Our aim was to use a locally developed handover tool to increase frequency of adequate physician handover during overnight shift change by 50% in 4 months. Methods: Using published best practices, local observational data, and stakeholder input, we determined critical components of ED handovers. We developed a structured communication tool for two unique populations in our ED: ED-VITAL for patients receiving active ED care; ED-VSA for patients who are admitted/referred. Strategies used to implement the tool included: engagement of staff physicians to introduce &amp; modify the tool; formal education and training to ED residents; and provision of cognitive aids. A QI coordinator conducted direct observations of handovers using convenience sampling. We provided feedback to staff and resident physicians, and used their input to continuously modify the tool. The main outcome measure was adequate patient handover, defined as verbal communication of 50% of critical handover components, or documentation of key information on an electronic note. Process measures included tool utilization characteristics. Balance measures included time metrics such as handover duration. We present run charts and qualitative statistics. Results: We assessed 368 individual patient handovers (93 pre- &amp; 275 post-implementation). The median proportion of patients in active ED care who were verbally handed over increased from 75% to 100%. The median proportion of adequate handovers improved from 50% to 72%. The time to deliver handover increased by 13 seconds per patient. Qualitative feedback from end users was positive overall, particularly for communication quality and resident educational value. Conclusion: Use of a standardized handover tool improved both verbal and documented communication during shift change. A customized approach, sensitive to local context, was important to successful implementation. Residents play a large role in handovers; strategies to improve handover processes that emphasize medical education appear to enhance success. Future PDSA cycles will focus on interventions to further enhance the utilization of the tool, and to measure direct impact on clinical outcomes.

P078: Handover education in Canadian adult and pediatric emergency medicine residencies: a national survey and needs assessment

Introduction: Emergency department handover is a high-risk period for patient safety. A recent study showed a decreased rate of preventable adverse events and errors after implementation of a resident hand-off bundle on pediatric inpatient wards. In a 2013 survey by the Canadian Associations of Internes and Residents, only 11% of residents in any discipline stated they received a formal teaching session on handover. Recently, the CanMEDS 2015 Physician Competency Framework has added safe and skillful transfer of patient care as a new proficiency within the collaborator role. We hypothesize that significant variation exists in the current delivery and evaluation of handover education in Canadian EM residencies. Methods: We conducted a descriptive, cross-sectional survey of Canadian residents enrolled in the three main training streams of Emergency Medicine (FRCP CCFP-EM, PEM). The primary outcome was to determine which educational modalities are used to teach and assess handover proficiency. Secondarily, we described current sign-over practices and perceived competency at patient handover. Results: 130 residents completed the survey (73% FRCP, 19% CCFP-EM, 8% PEM). 6% of residents were aware of handover proficiency objectives within their curriculum, while 15% acknowledged formal evaluation in this area. 98% of respondents were taught handover by observation of staff or residents on shift, while 55% had direct teaching on the job. Less than 10% of respondents received formal sessions in didactic lecture, small group or simulation formats. Evaluation of handover skills occurred primarily by on shift observation (100% of respondents), while 3% of residents had received assessment through simulation. Local centre handover practices were variable; less than half of residents used mnemonic tools, written or electronic adjuncts. Conclusion: Canadian EM residents receive variable and sparse formal training and assessment on emergency department handover. The majority of training occurs by on shift observation and few trainees receive instruction on objective tools or explicit patient care standards. There exists potential for further development of standardized objectives, utilization of other educational modalities and formal assessments to better prepare residents to conduct safer patient handoffs.

Evaluation of Factors Affecting Emergency Department Handovers; Experience of a Military Hospital

Evaluation of Factors Affecting Emergency Department Handovers; Experience of a Military Hospital

Handover of patients: a topical review of ambulance crew to emergency department handover

Handover has major implications for patient care. The handover process between ambulance and emergency department (ED) staff has been sparsely investigated. The purpose of this paper is, based on a literature review, to identify and elaborate on the major factors influencing the ambulance to ED handover, and to bring suggestions on how to optimize this process. A literature search on handovers to EDs was performed in PubMed, Embase, Web of Science and Cochrane databases. A total of 18 papers were included. Issues regarding transfer of information are highlighted. Newer studies suggest that implementing a structured handover format holds the possibilities for improving the process. Electronic equipment could play a part in reducing problems. Cultural and organizational factors impact the process in different ways. The professions perceive the value and quality of information given differently. Giving and taking over responsibility is an important issue. The handover of patients to the ED has the potential to be improved. Cultural issues and a lack of professional recognition of handover importance need to be approached. Multidisciplinary training in combination with a structured tool may have a potential for changing the culture and improving handover.

Analysis and impact of delays in ambulance to emergency department handovers

Delays in the clinical handover of patient care from emergency medical services (EMS) to the ED because of ED crowding are a substantial problem for many EMS systems. This study was conducted to quantify handover delays experienced by the Ambulance Service of New South Wales (ASNSW), and to investigate patient and system factors associated with handover delay. A retrospective study of EMS dispatch and ambulance patient care records was conducted for all patients transported by ASNSW in January/April/July/October 2009. Patient characteristics and time intervals were summarised using descriptive statistics, with handover delay categorised as <30 min, 30-60 min and ≥60 min. Times are reported as HH:MM:SS. Partial proportional odds models were used to investigate factors associated with delays. Of 141 381 transports, 12.5% of patients experienced a handover delay of 30-60 min, and 5% a delay of ≥60 min. The median handover interval was 00:15:46 (IQR 00:08:58-00:24:52, maximum 08:43:13). Patients transported to large hospitals were more likely to experience a delay of ≥30 min (odds ratio [OR] 14.57, 95% CI 11.41-18.60) or ≥60 min (OR 15.75, 95% CI 12.27-20.23) than those transported to small hospitals. Patients in major cities were more likely to experience delays than those in other areas, and patients ≥65 years were more likely to experience delays than those <16 years. Delays were most likely in winter. Cardiac and major trauma patients had the lowest likelihood of experiencing delays. Handover delays are relatively common at the EMS/ED interface in New South Wales, and are most pronounced at large hospitals, in urban areas and during winter.

A Proactive Approach to the Coagulopathy of Trauma: The Rationale and Guidelines for Treatment

Prevalence of coagulopathy in trauma According to the British Committee for Standards in Haematology and the American College of Pathologists, prolongation of the activated partial thromboplastin time (APTT) and prothrombin...

“ThinkSpine – the Management of Spinal Cord Injuries. Module 1: Accident Scene, Patient Transport and Emergency Department Handover”. Interactive DVD

“ThinkSpine – the Management of Spinal Cord Injuries. Module 1: Accident Scene, Patient Transport and Emergency Department Handover”. Interactive DVD

Emergency Physician to Admitting Physician Handovers: An Exploratory Study

Current emphasis on the number of deaths due to medical errors has pushed the patient safety issue to the forefront at many medical institutions. The Institute of Medicine's recommendation for improved coordination and collaboration between physicians, as well as the paucity of related literature, has led the authors to explore the nature of the handover between emergency department and admitting physicians. Research was conducted at two Ohio hospitals to document the phases and issues found in emergency department (ED) handovers. The phases for ED handovers were similar to those found in shift changes in other types of industries (e.g., paper mill, air traffic control) with minor variations in the order of the phases. Three areas were identified where potential errors could occur including the spoken communication between physicians, selection of diagnostic tests based on the specific admitting physician, and the use of surrogates by the admitting physician. Physicians identified the level of trust in ED resident physicians, incomplete handovers between ED physicians at their shift change, differences in exams and treatment plans based on admitting physician, and notification of possible admission prior to receiving results for exams as potential problem areas. The findings of this research illustrate the need for future research into physician communication. These studies have tremendous opportunity to enable the Institute of Medicine's goal of improving communication between physicians for better patient care and outcomes.