Elsevier

Injury

Volume 41, Issue 5, May 2010, Pages 460-464
Injury

Assessing clinical handover between paramedics and the trauma team

https://doi.org/10.1016/j.injury.2009.07.065Get rights and content

Abstract

Introduction

The aim of effective clinical handover is seamless transfer of information between care providers. Handover between paramedics and the trauma team provides challenges in ensuring that information loss does not occur. Handover is often time-pressured and paramedics’ clinical notes are often delayed in reaching the trauma team. Documentation by trauma team members must be accurate. This study evaluated information loss and discordance as patients were transferred from the scene of an incident to the Trauma Centre.

Methods

Twenty-five trauma patients presenting by ambulance to a tertiary Emergency and Trauma Centre were randomly selected. Audiotaped (pre-hospital) and videotaped (in-hospital) handover was compared with written documentation.

Results

In the pre-hospital setting 171/228 (75%) of data items handed over by paramedics to the trauma team were documented and in the in-hospital handover 335/498 (67%) of information was documented. Information least likely to be documented by trauma team members (1) in the pre-hospital setting related to treatment provided and (2) in the in-hospital setting related to signs and symptoms. While 79% of information was subsequently documented by paramedics, 9% (n = 59) of information was not documented either by trauma team members or paramedics and constitutes information loss. Information handed over was not congruent with documentation on seven occasions. Discrepancies included a patient's allergy status and sites of injury (n = 2). Demographic details were most likely to be documented but not handed over by paramedics.

Conclusion

By documenting where deficits in handover occur we can identify points of vulnerability and strategies to capture this information.

Introduction

The delivery of high quality care necessitates that there is effective communication between providers. At each juncture of care, whether it is at shift changeover or when patients move across care boundaries, opportunities exist for communication errors to occur and for information to be lost. Communication errors are costly, both in human5 and economic cost.2, 5, 10 The interface between paramedics and the trauma team provides a particularly vulnerable period for communication errors to occur. There is often little time to document extensive information about the patient's condition in transit to hospital, resulting in substantial dependence on memory by paramedics when providing a verbal handover. Written documentation from paramedics is often not made available to the trauma team for some time after the patients’ arrival. The complex nature of trauma events1 and the time critical nature of transmitting information to multiple people with many interruptions, coupled with the need for receiving trauma teams to rely on memory when paper documentation is not present increases risk that information will be lost or misinterpreted.6, 12 A study undertaken to identify whether information was retained following verbal handover in the trauma setting found that only 34% of information verbalised by paramedics was recalled by receiving physicians for patients who had suffered severe trauma.12 To our knowledge no study has published quantification of information loss, constituting information handed over but not documented, and information discordance between paramedics and the receiving trauma team.

The aim of this study was therefore to identify (1) whether information handed over by paramedics prior to and on arrival in the Trauma Centre was accurately documented by trauma team members; and (2) whether information was documented by paramedics but not handed over to trauma team members. If information was not recorded or inaccurately documented, we aimed to describe where this was most likely to occur. Ethics approval for this study was provided by relevant Institutional Ethics Committees.

Section snippets

Study setting and population

This study took place between August 2007 and July 2008 at the Alfred Hospital a 350 bed tertiary teaching hospital in Melbourne, Australia. The Level 1 Emergency and Trauma Centre treats approximately 47,000 emergency patients annually. In 2005–2006 it received 806 major trauma cases (ISS > 15) representing 55% of all major trauma cases in Victoria.16

Patient selection

Patients included in this study must have suffered a major injury and been bought into the hospital by either road or air ambulance. As this was

Results

Twenty-five cases were randomly selected from a database which collected details on all patients presenting to trauma bays in the hospital. Nine cases were identified for the time period 0701–1530 h, eight for the period 1531–2330 h and eight for the period 2331–0700 h. Patients were admitted as a result of motor vehicle collisions (n = 5), pedestrians struck by a motor vehicle (n = 4), motorbike collisions (n = 4), falls from a height (n = 3), assaults (n = 4), traumatic amputation (n = 1), crush injury (n = 

Discussion

This study evaluated information loss and discordance as 25 patients were transferred from the scene of an incident to the Emergency and Trauma Centre and found that in the pre-hospital setting 75% of information handed over was documented and in the in-hospital handover 67% of information was documented. Most information handed over by paramedics was subsequently recorded in the PCR (79%) or documented by trauma team members. However, nine percent of data items were not documented at all. Most

Conflict of interest statement

There are no conflicts of interest declared by any authors.

Acknowledgements

This project has been funded by the Transport Accident Commission. The authors would like to acknowledge support for this project provided by Noelle McCabe of Ambulance Victoria and Emergency and Trauma Centre staff in the Alfred Hospital. SME is supported by a National Health and Medical Research Council (NHMRC) Australian Based Public Health Fellowship.

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