Assessing clinical handover between paramedics and the trauma team
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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