Emergency Medical Services
Background: Clinical handover between emergency medical services (EMS) and the hospital trauma team can be subject to errors that may negatively affect patient care. Thus far, there has been limited evaluation of the quality of EMS handover. As such, we sought to characterize handover practices from EMS to the trauma team, identify areas for improvement, and determine if there is a need for standardization of current handover practices.
Methods: Data were prospectively collected over a nine-week period by a trained observer at a level one trauma centre using a previously validated handover framework. Date/times of data collection were randomly selected. Categories of metrics collected included duration and structure of the handover, information shared, questions and interruptions, and perceptions of EMS, nurses, and trauma team leaders (TTLs) about the quality of the handover according to a bidirectional Likert scale.
Results: A total of 79 formal verbal handovers were observed. Most handovers occurred after patient transfer (77%), and information most often communicated included any mention of identification (99%), mechanism of injury (96%), injuries and/or symptoms (97%), and signs in the form of initial assessment of either airway, breathing, circulation, or disability (92%). However, information was often missing regarding airway status (22%), breathing status (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. There was significant repetition of information, with 35% of all questions questioning information that had already been given. The majority of handovers (61%) involved parallel conversations amongst the trauma team, indicating a lack of active listening. There was a statistically significant disparity between the perceptions of EMS regarding the self-evaluation of the quality of their handovers and the perceived quality as determined by the nurses and TTLs.
Conclusion: We have identified the need to standardize handover due to poor information communication, a lack of structure, information repetition, a lack of active listening, and discordant expectations between EMS and nurses and TTLs. These data will guide the development of a co-constructed framework integrating the views of all members of the trauma team and emergency medical services.