Ep 73 - ED Handover in the resus room: A panel discussion at SMACC DUB. (Part 1)

Enhancing Pre-Hospital to Hospital Handover: Insights from SMACC Dublin

The SMACC Dublin conference provided a valuable platform for discussing the crucial handover process from pre-hospital teams to hospital staff. This transition is essential for patient safety and continuity of care, as it involves conveying critical information from emergency responders to hospital-based healthcare professionals. The discussion at the conference highlighted several key issues, best practices, and strategies to improve this critical interface.

The Emotional Landscape and Communication Challenges

Dr. Natalie May, reflecting on her shift from hospital to pre-hospital care, emphasized the emotional challenges and the need for empathy and understanding between both teams. Pre-hospital providers often face a tense environment upon hospital arrival, with varying degrees of reception from the hospital team. This tension can arise from perceived disrespect or a lack of understanding of the pre-hospital team's challenges, which can complicate the handover process.

A significant issue in handover is the lack of structured communication. The fast-paced environment of the emergency department (ED) can pressure pre-hospital providers to quickly pass on patients and information, sometimes resulting in incomplete or rushed handovers. To address this, the use of structured communication tools like the AD MISSED acronym (Age, Date/Time, Mechanism of Injury, Injuries, Signs/Symptoms, Treatments, and Decisions) was recommended. This structure helps ensure that all essential information is conveyed systematically, minimizing the risk of information loss.

Best Practices for Handover

One highlighted best practice is the implementation of a clear and consistent protocol. For instance, a Texas hospital has adopted a "hands-off" period during handover, where the receiving team does not intervene until the pre-hospital team has completed their report. This approach helps maintain focus on the verbal communication of critical details without distractions, ensuring a comprehensive transfer of information.

The role of the trauma team leader is also critical. They act as the primary point of contact, receiving the handover and ensuring that all relevant team members understand the conveyed information. The trauma team leader is responsible for verifying the accuracy of the information, clarifying any uncertainties, and coordinating subsequent actions. This leadership role is crucial in maintaining a smooth and efficient handover process.

Overcoming Communication Barriers

Differences in communication styles and preferences between hospitals can pose challenges. The discussion emphasized the need for pre-hospital teams to be adaptable, potentially rehearsing handovers and using aids like whiteboards. Regular joint training sessions between pre-hospital and hospital teams were recommended to align expectations and familiarize each side with the other's protocols. The use of digital tools, such as secure messaging apps, can also facilitate better communication and continuity of care.

The physical environment during handover significantly impacts its effectiveness. A calm, organized setting with minimal interruptions is ideal for ensuring a thorough transfer of information. Designating a specific area for handovers and equipping it with necessary tools, such as a whiteboard and a scribe, can improve the clarity and accuracy of the communication.

The Importance of Feedback

Immediate feedback after handover is crucial for continuous improvement. It allows pre-hospital providers to understand the outcomes of their interventions and the patient's progression. This real-time feedback can highlight areas for protocol refinement and training. Additionally, formal long-term feedback mechanisms, such as follow-up meetings or debriefings, are vital for providing a complete picture of the patient's journey, helping both pre-hospital and hospital teams improve their practices.

Building a Culture of Respect and Understanding

A successful handover process is built on mutual respect and understanding between pre-hospital and hospital teams. Acknowledging the expertise and challenges faced by each group fosters a more cooperative and supportive environment. This respect is essential for enhancing patient care and ensuring a smooth transition from one care setting to another.

To build this culture of respect, regular interdisciplinary workshops and social events can help break down barriers and build rapport among healthcare professionals. Recognizing the unique pressures and responsibilities of each team member contributes to a more harmonious and effective handover process.

Conclusion: Towards a Seamless Continuum of Care

The discussions at SMACC Dublin underscored the importance of an effective handover in emergency medicine. By adopting structured communication protocols, ensuring clear leadership, and fostering a culture of continuous feedback and mutual respect, the gap between pre-hospital and hospital care can be bridged. The ultimate goal is to create a seamless continuum of care, where the transition between healthcare teams is smooth, efficient, and centered on the patient's best interests.

This integrated approach not only improves patient outcomes but also enhances job satisfaction among healthcare providers by reducing miscommunications and misunderstandings. The handover process is a critical component of patient care that requires ongoing attention and improvement.

In conclusion, effective handover practices are essential for ensuring patient safety and continuity of care. The insights from SMACC Dublin provide valuable guidance on refining these practices. By fostering a culture of learning, respect, and collaboration, healthcare providers can ensure that every patient transition is handled with the utmost professionalism and care.