EMS MEd Blog

EMS Handoffs: How Can We Improve?

A Case

It is a typical day in the emergency department. An 83 yo female is brought in by EMS after family called 911 because the patient was not herself.  The patient’s vital signs are reportedly within normal limits, so she is triaged to a regular room in the emergency department where handoff is given from paramedic to nurse.  The physician, who is in another room, is not present for the signout.

Ten minutes later, the physician walks into the room to see the patient.  Her family is not present.  Because paramedics had to leave rapidly for another call, the prehospital patient-care record is not in the chart and there is minimal documentation of what was communicated in the handoff.  The patient, who is oriented only to self, states only, “I’m not sure why I’m here.”  The physician continues with his physical exam, hoping he can find other clues as to why the patient is here. 

For Discussion

Whenever they occur, handoffs are a critical component of quality patient care and have enormous influence on patient trajectory within the clinical environment.  For a multitude of reasons, handoffs between prehospital and in-hospital healthcare providers are logistically difficult and vary in quality.

What are some of the barriers you have encountered to quality patient handoffs from prehospital to in-hospital providers on the radio, at bedside and in written documentation?  Most importantly, what initiatives has your EMS system implemented to address this issue in patient care?

Please leave your comments below.  A review of the current literature and a summary of the comments will be published in two weeks.