Abstract
In Italy, emergency department (ED) triage is a complex and delicate interface in which different emergency healthcare providers interact: physicians, nurses, and pre-hospital rescuers. There are significant differences in the communication, training, and abilities of these providers. Communication failures during the pre-hospital/hospital interface have been identified as a major preventable cause of patient harm. We previously evaluated handover in simulated scenarios, and developed specialized handover training for pre-hospital emergency rescuers. The purpose of this study is to evaluate communication during the clinical handover between pre-hospital to ED staff, using realistic scenarios. A nurse, trained through high-fidelity simulation handover scenarios, used our adapted ISBAR tool to evaluate inter-professional communication at triage. We evaluated and statistically analyzed 240 handovers performed by pre-hospital rescuers over nine observing shifts. On the whole, the data analysis highlights a lack of communication standards, a lack of formal transfer of responsibility of patient care, and a marked inconsistency in information communicated by every professional group examined. Only those rescuers who were previously trained in handover performed 100 % of the ISBAR tool items. The information most often communicated was the reason for the call, (85 %) and the information least often communicated was the complete ABCDE patient survey (1 %). Currently, ED personnel receive poor verbal information from pre-hospital providers. The general habit of pre-hospital providers is to give different written reports to the triage nurses without a true shared transfer of responsibility. This lack of standardization in communication presumably has an adverse impact upon patient care.
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Acknowledgments
The authors would like to thank Dr. Stefano Grifoni, Chief, Emergency Department, Careggi University Hospital, as well as Il Gruppo Formatori Triage Toscano (Tuscan Triage Trainers Workgroup), for their valuable assistance and support. The group members are as follows: Anna Todisco (ASL 1), Paola Biancalana, Carlo Raffaele Gravili (ASL 2), Augusto Cruciani, Dania D’amato, Stefano Gori (ASL 4), Lucia Porcaro, Paolo Chiaradia (ASL 4), Maurizio Cerbone, Michela Carugini Orzalesi (ASL 6), Sabrina Tellini (ASL 7), Susanna Petrelli, Claudio Sorini, Paolo Cavicchioli, Claudia Betti (ASL 8), Laura Petrocchi, Andrea Barbieri (ASL 9), Monica Giusti, Massimo Gabellieri (ASF), Calogera Leto (ASL 11), Federica Franchi (ASL 12), Riccardo Baldassini (AOU Careggi), Antonietta Pandolfo, Mauro Rossi (AOU Pisa), Mauro Olivi (AOU Siena). The authors would also like to thank Meaghan Cussen, Beth Israel Deaconess Medical Center, Boston, MA, USA, for her English editing assistance.
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Appendix: ISBAR Tool
Appendix: ISBAR Tool
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Di Delupis, F.D., Mancini, N., di Nota, T. et al. Pre-hospital/emergency department handover in Italy. Intern Emerg Med 10, 63–72 (2015). https://doi.org/10.1007/s11739-014-1136-x
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DOI: https://doi.org/10.1007/s11739-014-1136-x