Patient handoffs continue to present challenges and risk to hospitals.
In fact, according to the Joint Commission Center for Transforming Healthcare, “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.” For patients brought to the hospital by ambulance, care actually begins with “first medical contact” by Emergency Medical Services, which adds additional layers to the handoff issue. From the time the 911 call is placed to the time the patient is treated by a physician or specialist team (as is the case for lifesaving time-sensitive acute care such as STEMI, Stroke, Trauma or Sepsis), information has changed hands up to eight times. Each handoff compounds a very large (and very concerning) margin for error. Remember playing “Telephone” as a child? One person whispered a statement to another person, who passed it along to the next… by the time the 4th person received it, it was hilariously different than the original message. Well, in a life or death situation, there’s nothing hilarious about inaccurate or missing information.
Let’s examine the chain of care-related information.
A call is made to 911- a brief background of the patient’s emergency and situation are given to the dispatcher, who passes that info along to the EMS ambulance responding. First responder paramedics and EMTs arrive at the scene, assess the patient, obtain a history and initiate care. They gather additional data and vitals, select the destination hospital and prepare for transport. At some point EMS either consults with a hospital-based nurse or physician for medical direction or simply calls or radios in a summary as a notification to the receiving emergency department. This patient report is (hopefully) passed to other ED staff in advance of the ambulance arrival. That’s handoff number three already and the patient has not yet arrived. Upon arrival, the patient is handed off to waiting nursing staff, who collect a rehash of the care summary from EMS before they leave. As ED providers take over patient care, nurses pass all of this data to arriving physicians, usually reiterated verbally or via jotted notes- from which treatment ensues. For acute care cases, there are yet additional time-sensitive handoffs to CT-Scan or Cath-Lab, and to specialists from cardiology, neurology, and trauma.
Was it a bit tricky to follow all of that?
Seems pretty easy for details to get lost in translation, doesn’t it? This is not a new issue, which is why the patient handoffs between EMS and the ED is termed “a critical moment in patient care” in a recent NAEMSP blog. With today’s emphasis on patient outcomes and reducing cost and risk, the use of Mobile Telemedicine, HIPAA secure notifications, and digital forms are viable, cost-effective tools to drastically reduce that error percentage. Which brings us back to the question. Does your EMS-ED handoff process need a hand?