Patient Handover: EMS “Time-Outs” in the multi-trauma delivery.
“Prehospital communication is a critical first step towards ensuring efficient management of critically injured patients during trauma resuscitation.”¹ Information transfer for trauma patients is especially crucial, as the interdisciplinary team must provide potentially life-saving interventions and decisions very quickly. If this information transfer, from EMS to ED receiving staff, is fragmented this can cause preventable major patient harm.
Clinical handover refers to “the transfer of professional responsibility and accountability for some or all aspects for a patient, or group of patients, to another person or professional group on a temporary or permanent basis.”² Information from paramedics to the ED staff during a handover have been found to be inconsistent, ignored, interrupted and repeated more than one time.
Patient safety and the seamless transition of patient information has become a national concern with many studies documenting suggestions and creating intensive projects – “Priority Program 5 – National Clinical Handover Initiative”, “administered by the World Health Organization (WHO) Patient Safety Alliance.”³
As mentioned in “Resources for Optimal Care of the Injured Patient, 2014, Ch.3, pg. 26 “”some trauma programs have found that EMS “time-outs” to allow for the unfettered exchange of a patient summary are useful in ensuring continuity of care.”
“In 2013, the National Safety and Quality Health Service standards identified the need for established systems and strategies for clinical handover.” (time-out) One model that is gaining popularity is the IMIST-AMBO.
A structured EMS time-out demonstrates opportunities for a strong positive platform for the performance of seamless transition of care, omission of relevant or critical patient information, and mutual respect of all members of the prehospital and interdisciplinary patient care team.
IMIST-AMBO Handover Protocol
Identification (e.g. patient’s name, age, sex)
Mechanism of injury or medical complaint (e.g. presenting problem, events)
Injuries or information related to the complaint (e.g. symptoms and/or injuries)
Signs (e.g. vital signs, HR, RR, BP, Temp. BS, GCS)
Treatment and trends (e.g. treatment administered and patient’s response to treatment, trends in vital signs)
Medications (patient’s regular meds)
Background history (medical hx)
Other information (relatives present, social)
How does it work?
Velvet Reed-Shoults, RN, BSN, MHA, CEN
TTA Time Out Video
- Supporting Information Use and Retention of Pre-Hospital Information during Trauma Resusitation: A Qualitative Study of Pre-Hospital Communications and Information Needs. Zhan Zhang, MS Aleksandra Sarcevic, PhD, and Randall S. Burd, MD, PhD; AMIA Annu Symp Proc. 2013; oublished online 2013 Nov. 16.
- Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. Sydney, 2012.
- Information Transfer for Multi-Trauma Patients on Discharge from the Emergency Department: Mixed Method Narrative Review. Pauline Calleja RN, MANP, MRCNA; Leanne M. Aitken RN, PhD, FRCNA; Marie L. Cooke RN, PhD.
- Resources for Optimal Care of the Injured Patient 2014. Committee on Trauma. American College of Surgeons.
- Society of Trauma Nurses. traumanurses.org/online communities. Velvet.email@example.com. Director of Trauma Services Mercy Hospital, Springfield, Missouri.
- Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members; Sue M Evans, Angela Murray, Ian Patrick, Mark Fitzgerald, Sue Smith, Peter Cameron. Qual Saf Health Care 2010; 19:e57.