BACKGROUND: Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients' subsequent hospital treatment and trajectory of care. AIM: The study's aims were to: (1) identify the existing structure of paramedic-to-emergency staff handovers by video recording and analysing them; (2) involve practitioners in reflecting on practice using the footage; (3) combine those reflections with formal analyses of these filmed handovers to design a handover protocol; (4) trial-run the protocol; and (5) assess the protocol's enactment. METHOD: The study was a 'video-reflexive ethnography' involving: structured analysis of videoed handovers (informed by ED clinicians' and ambulance paramedics' comments); ED clinicians and ambulance paramedics viewing their own practices; and rapid at-work training and feedback for paramedics. A five-question pre- and post-survey measured ED triage nurses' perceptions of the new protocol's impact. In total, 137 pre- and post-handovers were filmed involving 291 staff, and 368 staff were educated in the use of the new protocol. RESULTS: There was agreement that Identification of the patient, Mechanism/medical complaint, Injuries/information relative to the complaint, Signs, vitals and GCS, Treatment and trends/response to treatment, Allergies, Medications, Background history and Other (social) information (IMIST-AMBO) was the preferred protocol for non-trauma and trauma handovers. Uptake of IMIST-AMBO showed improvements: a greater volume of information per handover that was more consistently ordered; fewer questions from ED staff; a reduction in handover duration; and fewer repetitions by both paramedics and ED clinicians that may suggest improved recipient comprehension and retention. CONCLUSION: IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the resulting protocol, strengthened ED clinicians' and ambulance paramedics' sense of ownership over the protocol and bolstered their peers' willingness to adopt it.
BACKGROUND: Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients' subsequent hospital treatment and trajectory of care. AIM: The study's aims were to: (1) identify the existing structure of paramedic-to-emergency staff handovers by video recording and analysing them; (2) involve practitioners in reflecting on practice using the footage; (3) combine those reflections with formal analyses of these filmed handovers to design a handover protocol; (4) trial-run the protocol; and (5) assess the protocol's enactment. METHOD: The study was a 'video-reflexive ethnography' involving: structured analysis of videoed handovers (informed by ED clinicians' and ambulance paramedics' comments); ED clinicians and ambulance paramedics viewing their own practices; and rapid at-work training and feedback for paramedics. A five-question pre- and post-survey measured ED triage nurses' perceptions of the new protocol's impact. In total, 137 pre- and post-handovers were filmed involving 291 staff, and 368 staff were educated in the use of the new protocol. RESULTS: There was agreement that Identification of the patient, Mechanism/medical complaint, Injuries/information relative to the complaint, Signs, vitals and GCS, Treatment and trends/response to treatment, Allergies, Medications, Background history and Other (social) information (IMIST-AMBO) was the preferred protocol for non-trauma and trauma handovers. Uptake of IMIST-AMBO showed improvements: a greater volume of information per handover that was more consistently ordered; fewer questions from ED staff; a reduction in handover duration; and fewer repetitions by both paramedics and ED clinicians that may suggest improved recipient comprehension and retention. CONCLUSION:IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the resulting protocol, strengthened ED clinicians' and ambulance paramedics' sense of ownership over the protocol and bolstered their peers' willingness to adopt it.
Authors: Ken Catchpole; David M Neyens; James Abernathy; David Allison; Anjali Joseph; Scott T Reeves Journal: BMJ Qual Saf Date: 2017-09-28 Impact factor: 7.035
Authors: Milisa Manojlovich; Richard M Frankel; Molly Harrod; Alaa Heshmati; Timothy Hofer; Elizabeth Umberfield; Sarah Krein Journal: BMJ Qual Saf Date: 2018-07-14 Impact factor: 7.035
Authors: Remco H A Ebben; Pierre M van Grunsven; Marie Louise Moors; Peter Aldenhoven; Jordan de Vaan; Roger van Hout; Theo van Achterberg; Lilian C M Vloet Journal: Scand J Trauma Resusc Emerg Med Date: 2015-04-16 Impact factor: 2.953
Authors: Annelieke Maria Karien Harmsen; Leo Maria George Geeraedts; Georgios Fredericus Giannakopoulos; Maartje Terra; Herman M T Christiaans; Lidwine Brigitta Mokkink; Frank Willem Bloemers Journal: Scand J Trauma Resusc Emerg Med Date: 2017-07-11 Impact factor: 2.953
Authors: Darren Flynn; Richard Francis; Shannon Robalino; Joanne Lally; Helen Snooks; Helen Rodgers; Graham McClelland; Gary A Ford; Christopher Price Journal: BMC Emerg Med Date: 2017-02-23
Authors: David Fitzpatrick; Michael McKenna; Edward A S Duncan; Colville Laird; Richard Lyon; Alasdair Corfield Journal: Scand J Trauma Resusc Emerg Med Date: 2018-06-01 Impact factor: 2.953