Clinical handover of patients arriving by ambulance to the emergency department – A literature review

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Abstract

Aim

To provide a critical review of research on clinical handover between the ambulance service and emergency department (ED) in hospitals.

Method

Data base and hand searches were conducted using the keywords ambulance, handover, handoff, emergency department, emergency room, ER, communication, and clinical handover. Data were extracted, summarised and critically assessed to provide evidence of current clinical handover processes.

Results

From 252 documents, eight studies fitted the inclusion criteria of clinical handover and the ambulance to ED patient transfer. Three themes were identified in the review: (1) important information may be missed during clinical handover; (2) structured handovers that include both written and verbal components may improve information exchange; (3) multidisciplinary education about the clinical handover process may encourage teamwork, a shared common language and a framework for minimum patient information to be transferred from the ambulance service to the hospital ED.

Conclusion

Knowledge gaps exist concerning handover information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff training and evaluation of recommended strategies to improve clinical handover. Evidence of strategies being implemented and further research is required to examine the ongoing effects of implementing the strategies.

Introduction

Communication failures are a major cause of adverse events in clinical settings (Australian Commission on Safety and Quality in Health Care, ACSQHC, 2008). Governing bodies, including the World Health Organisation (WHO, 2008), the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2008) and the National Patient Safety Agency (Dept. of Health, 2004) recognise the importance of strategies aimed at improving information exchange between health care professionals as key to minimising the risk of patients experiencing an adverse event. Clinical handover has been identified as one episode of care when communication failures can occur (ACSQHC, 2008). In Australia, a country with a population of nearly 22 million people (ABS, 2009), it is estimated that 7.68 million handovers occur annually within hospitals (ACSQHC, 2008). Of those handovers, an estimated 1.6 million occur between the ambulance service and the Emergency Department (ED) (ACSQHC, 2009). This type of clinical handover often represents the first physical interface of pre-hospital and hospital staff where information regarding a patient’s clinical condition, professional responsibility and accountability are transferred from one healthcare provider to another (The American College of Obstetricians and Gynecologists, ACOG, 2007; Australian Medical Association, AMA, 2006).

Clinical handover of patient information and transfer of responsibility between health care disciplines such as the ambulance service and ED hospital staff often occur in a setting of high patient acuity and overcrowding (Wilson, 2007). These factors create an environment of busyness, interruptions and distractions that are reported to impact on the quality of clinical handover (ACSQHC, 2008). Numerous clinical handover studies have been published that have focused on investigating handover between nurses when transferring a patient from one ward to another (McFetridge et al., 2007) or between nurses (Cahill, 1998, Chaboyer et al., 2008, Clemow, 2006; Lally, 1999, Miller, 1998, Sexton et al., 2004) and doctors at change of shift times (Fassett et al., 2007, Singer and Dean, 2006). However, investigations of handovers within the ED (Bomba and Prakash, 2005, Currie, 2002, Ye et al., 2007) and in particular, where ambulance personnel have been brought into the examination of the handover process, have been limited (Owen et al., 2009, Thakore and Morrison, 2001, Walker, 1995).

A literature review was undertaken of studies related to clinical handover from the ambulance service to hospital staff in the ED to determine the current level of knowledge and answer the following questions:

  • 1.

    What are the barriers to clinical handover between the ambulance service and the ED?

  • 2.

    What handover models have previously been utilised for the ambulance to ED clinical handover?

  • 3.

    What are the gaps in the evidence base on clinical handover between the ambulance service and the ED?

Section snippets

Method

A data base literature search of Medline, CINAHL and Scopus was conducted using the key search terms, singly or in combination, of: “ambulance”, “handover”, “handoff“, “emergency department” “emergency room”, “ER”, “communication”, and “clinical handover”. Results were limited to the English language. A hand search of reference lists in the retrieved literature was conducted to ensure as many eligible papers as possible were included.

Results

From a total of 252 papers scanned, eight research studies that were specific to the clinical handover from ambulance personnel to ED staff were found (Fig. 1). All studies reviewed were non-experimental, descriptive or observational in design. Table 1 summarises in chronological order, the eight studies that reported ambulance personnel to ED staff handover. The purpose of these studies was to explore the perceptions and experiences of staff during handover or to report the results of direct

Discussion

Several issues regarding handover within the ambulance to ED clinical handover emerged from the review. A number of barriers to effective handover and gaps in evidence based knowledge have been identified.

Conclusion

A smooth transition of information and accountability from ambulance to hospital may assist in timely prioritisation of the correct type of medical and nursing treatment that will ultimately enhance the safety and quality of patient care. Although awareness of the importance of clinical handover is increasing, knowledge gaps on ambulance to ED handovers concerning quality and quantity of information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff

Conflict of interest

None declared.

Funding source

This review was funded by Queensland Health Nursing and Midwifery Research Grant 2008.

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