Zachary F Meisel1, Judy A Shea2, Nicholas J Peacock3, Edward T Dickinson4, Breah Paciotti5, Roma Bhatia6, Egor Buharin7, Carolyn C Cannuscio8. 1. Center for Emergency Care Policy Research, Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: zfm@upenn.edu. 2. Department of Medicine, Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 3. Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA. 4. Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, PA. 5. Center for Emergency Care Policy Research, Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, PA; Mixed Methods Research Lab, Perelman School of Medicine, Philadelphia, PA. 6. Mayo Medical School, Rochester, MN. 7. University of Pennsylvania, Philadelphia, PA. 8. Department of Family Medicine and Community Health, Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Abstract
STUDY OBJECTIVE: Patient handoffs are known as high-risk events for medical error but little is known about the professional, structural, and interpersonal factors that can affect the patient transition from emergency medical services (EMS) care to the emergency department (ED). We study EMS providers' perspectives to generate hypotheses to inform and improve this handoff. METHODS: We conducted focus groups with EMS providers recruited at 3 national and regional conferences from January to March 2011 until theme saturation was reached; 7 focus groups were conducted with 48 EMS providers. Deidentified transcripts and notes were entered into QSR NVivo, coded, and analyzed to identify themes. RESULTS: EMS providers identified themselves as advocates for their patients during the challenging EMS-to-ED handoffs. Providers identified normative challenges they encounter in their communications with hospital staff, and features of EMS and hospital protocols that either facilitate or undermine effective handoffs from the out-of-hospital environment to the ED. They identified 4 key potential ways to improve the structure and process of the handoff: (1) communicate directly with the ED provider responsible for the patient's care; (2) increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers; (3) standardize some (but not all) aspects of the handoff; and (4) harness technology to close gaps in information exchange. CONCLUSION: These exploratory findings suggest that the effect of increasing EMS interactions with emergency physicians, standardizing handoff processes, and fostering interprofessional learning represent opportunities for future study and may serve as potential solutions for the high-risk EMS-ED patient transition.
STUDY OBJECTIVE:Patient handoffs are known as high-risk events for medical error but little is known about the professional, structural, and interpersonal factors that can affect the patient transition from emergency medical services (EMS) care to the emergency department (ED). We study EMS providers' perspectives to generate hypotheses to inform and improve this handoff. METHODS: We conducted focus groups with EMS providers recruited at 3 national and regional conferences from January to March 2011 until theme saturation was reached; 7 focus groups were conducted with 48 EMS providers. Deidentified transcripts and notes were entered into QSR NVivo, coded, and analyzed to identify themes. RESULTS: EMS providers identified themselves as advocates for their patients during the challenging EMS-to-ED handoffs. Providers identified normative challenges they encounter in their communications with hospital staff, and features of EMS and hospital protocols that either facilitate or undermine effective handoffs from the out-of-hospital environment to the ED. They identified 4 key potential ways to improve the structure and process of the handoff: (1) communicate directly with the ED provider responsible for the patient's care; (2) increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers; (3) standardize some (but not all) aspects of the handoff; and (4) harness technology to close gaps in information exchange. CONCLUSION: These exploratory findings suggest that the effect of increasing EMS interactions with emergency physicians, standardizing handoff processes, and fostering interprofessional learning represent opportunities for future study and may serve as potential solutions for the high-risk EMS-ED patient transition.
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