Prospective Observational Multisite Study of Handover in the Emergency Department: Theory versus Practice

Area of Science:

• Emergency Medicine
• Healthcare Quality Improvement
• Patient Safety

Background:

• Effective patient handover in the emergency department (ED) is critical for patient outcomes and continuity of care.
• Current prehospital to ED handover practices require examination regarding their content, structure, and scope.

Purpose of the Study:

• To examine the current prehospital to ED handover practices.
• To assess the content, structure, and scope of information transfer during emergency medical service (EMS) to ED handovers.

Main Methods:

• A prospective, multicenter observational study was conducted.
• A specifically developed checklist was used to document 721 handover processes.
• Data were analyzed in relation to EMS staff qualifications, patient condition, and treatment priority.

Main Results:

• Nearly all handovers (99.4%) demonstrated deficits in structure and scope according to standardized mnemonics like ISBAR, MIST, and BAUM.
• Essential patient information such as age and time of emergency onset was frequently missing.
• Complete adherence to the ABCDE algorithm during handover occurred in only 4.3% of cases, with significant differences noted between occupational groups.

Conclusions:

• Significant inconsistencies persist in prehospital to ED patient information transfer despite standardization efforts.
• A comprehensive 'hand-off bundle' is recommended, incorporating a uniform mnemonic, staff education, training, and an audit process.
• Standardization is essential to improve the quality and safety of emergency patient handovers.