Clinical handover of patients arriving by ambulance to the emergency department – A literature review
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.
References (40)
- et al.
SBAR: a shared mental model for improving communication between clinicians
Journal on Quality and Patient Safety
(2006) - et al.
Patient handover: time for a change?
Accident and Emergency Nursing
(2007) Committee opinion: communication strategies for patient handoffs
Obstetrics and Gynecology
(2007)- AMA (Australian Medical Association), 2006. Safe Handover: Safe Patients, Guidance on Clinical Handover for Clinicians...
- Australian Bureau of Statistics, 2009. Australia’s Population. <http://www.abs.gov.au/> (accessed 09....
- Australian Commission on Safety and Quality in Health Care, 2008. Windows into Safety and Quality in Health Care,...
- Australian Commission on Safety and Quality in Health Care, 2009. The OSSIE Guide to Clinical Handover Improvement....
- et al.
A theoretical framework and competency-based approach to improving handoffs
Quality and Safety in Health Care
(2008) - Behara, R., Wears, R.L., Perry, S.J., Eisenberg, E., Murphy, A.G., Vanderhoef, M., Shapiro, M., Beach, C., Croskerry,...
- et al.
Description of the handover processes in Australian public hospitals
Australian Health Review
(2005)
The handover process and triage of ambulance-borne patients: the experiences of emergency nurses
Nursing in Critical Care
Patient’s perceptions of bedside handovers
Journal of Clinical Nursing
Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality
Pediatric Anesthesia
Bedside handover: quality improvement strategy to “transform care at the bedside”
Journal of Nursing Care Quality
Care plans as the main focus of nursing handover: information exchange model
Journal of Clinical Nursing
Improving the efficiency of patient handover
Emergency Nurse
A national survey of medical morning handover report in Australian hospitals
Medical Journal of Australia
Shared mental models enhance team performance
Nursing in Critical Care
Cited by (64)
Defining obstacles to emergency transfer of trauma patients: An evaluation of retriage processes from nontrauma and lower-level Illinois trauma centers
2022, Surgery (United States)Citation Excerpt :McElroy et al37 used the FMECA to develop a series of recommendations for advance notification by the transferring team, establishing roles and responsibilities of each participating team member and anticipatory guidance for the receiving team to improve the patient handoff process after liver transplantation. Standardized transfer criteria effectively mitigate information gaps and improve the continuity of care during handoffs between ambulance and ED teams,38 as well as between receiving centers and transferring centers.39,40 Further design work is needed to formulate the requirements and specifications of any novel standardized processes for an entire health system.
Emergency handover of critical patients. A systematic review
2021, International Emergency NursingBarriers to effective EMS to emergency department information transfer at patient handover: A systematic review
2020, American Journal of Emergency MedicineCitation Excerpt :Handovers by EMS endeavor to exchange such information, as well as allow providers to advocate for their patients, coordinate care, and transfer accountability [3,4,55]. Due to the importance of handovers and the frequency with which EMS handovers occur daily, there have already been multiple review articles of this topic [2,5-8]. These have aimed to identify a minimum data set for EMS handovers, challenges specific to EMS handovers, gaps in evidence, and difficulties in handing over deteriorating patients.
Clinician perspectives of a mental health consumer flow strategy in an emergency department
2018, CollegianCitation Excerpt :Clinician ownership and responsibility for the consumer consists of seven core elements: advocacy, autonomy, commitment, communication, follow-through, knowledge and teamwork which encompasses professionalism, consumer care and consumer safety (McLaren et al., 2013). There is a strong link between consumer responsibility and consumer safety that has been discussed in the context of clinical handovers of medical and nursing shift changes (Farhan, Brown, Woloshynowych, & Vincent, 2012; Smeulers, Lucas, & Vermeulen, 2014), between hospital departments (Horwitz et al., 2009) and different organisations (Bost, Crilly, Wallis, Patterson, & Chaboyer, 2010). Responsibility between departments prior to physical transfer of the consumer from the ED to the hospital ward is a complex situation and requires an unusual level of negotiation (Horwitz et al., 2009; Hilligoss & Cohen, 2013).
Impacts of an EMS Hospital Liaison Program on Ambulance Offload Times: A Preliminary Analysis
2022, Prehospital and Disaster Medicine