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Paramedic to trauma team verbal handover optimization - a complex interaction.
Shaun Cowan1, Patrick Murphy2, Michael Kim2
1From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North) cowan@ualberta.ca.
Standardized trauma handover formats like IMIST and ISOBAR are preferred over ad-lib communication. Key factors for effective trauma care include vital signs, logical structure, and minimizing distractions during patient transfer.
Area of Science:
- Emergency Medicine
- Trauma Care
- Healthcare Communication
Background:
- Effective handover of patients to the trauma team is critical for optimal trauma care.
- Current trauma handovers are often unstructured, leading to communication challenges between unfamiliar teams in chaotic environments.
- Standardization of emergency medical services (EMS) reports is needed for conciseness, key detail inclusion, and time limitation.
Purpose of the Study:
- To evaluate the effectiveness of structured handover formats compared to unstructured (ad-lib) communication during trauma patient transfer.
- To compare the ISOBAR (identify, situation, observations, background, agreed plan, and readback) and IMIST (identification, mechanism/medical complaint, injuries/information about complaint, signs, treatments) handover formats.
Main Methods:
- A single-blind randomized simulation trial was conducted with paramedics.
- Paramedics used either ad-lib, ISOBAR, or IMIST handover formats during simulated trauma scenarios.
- Handovers were assessed by the receiving trauma team and by experts through audiovisual recordings.
Main Results:
- Participant ratings indicated a preference for the IMIST (9/10) and ISOBAR (7.5/10) formats over ad-lib communication.
- Handover quality was perceived as higher when objective vital signs and a logical format were used.
- Factors such as confidence, team leadership, pre-transfer summarization, and lack of interruptions significantly impacted handover quality, more so than the specific format used.
Conclusions:
- Prehospital and hospital personnel agree on the preference for standardized trauma handover tools.
- Improving handover effectiveness can be achieved through confirming physiologic stability (including vital signs), reducing distractions, and implementing team summarization.
- While specific formats showed preference, a combination of structured elements and environmental factors determines overall handover quality.
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