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Studer Spotlight: Effective Care Transitions from EMS to the Emergency Department

Posted on Wed, Jan 20, 2016
Studer Spotlight: Effective Care Transitions from EMS to the Emergency Department

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Bob Murphy, RN, JD

Effective care transitions from Emergency Medical Services (EMS) to the Emergency Department (ED) are critical to providing safe and quality patient care. Both EMS and the ED team must develop the necessary skills to efficiently handover patients to provide appropriate care and has the potential to save lives and improve patient eligibility for time-sensitive therapies such as stroke or acute myocardial infarction care. Conversely, an Australian study showed that nearly one in 10 patients may be adversely affected as the result of poor handovers..

Effective care transitions actually start before a patient is even encountered. Here are a few important points:
 

  • EMS leaders and medical directors, working with ED physician leadership, should communicate regularly to plan, train and assess how transitions of care should be performed. They should agree on the minimum information expected to be shared about the patient from the scene, both en-route to the ED and upon arrival at the ED.
  • Mutual respect and an understanding of our roles is necessary. Both pre-hospital and ED teams work hard to do their best to care for patients and a recognition that we have different work environments, equipment, personnel resources and time pressures in which we provide care is critical. We are all members of the same team in providing excellent care.

Before the patient arrives at the ED:
EMS providers have a critical role in gathering and transferring essential information and should gather as much relevant information as feasible about the patient to share with ED providers. This includes:
 
  • Information that was available only to the EMS crew, including the patient’s living and social conditions (including indications of abuse or neglect), accident circumstances, key contacts, witnesses to events, and medication and problem lists.
  • When circumstances suggest that advance directives are in effect, EMS personnel should ask if a document is available and whether a copy can be transported with the patient.

While on scene or en-route to the ED, EMS agencies attempt to contact the ED by radio or phone. This brief report helps the ED staff know what resources to have in place when the patient arrives and can set the tone for the rest of the interaction and will impact care the patient receives.

The call by EMS should include:
 
  • A brief, but relevant history including why EMS was called and the chief complaint.
  • What EMS observed while on scene.
  • Relevant vital signs and assessment.
  • Treatment initiated so far and the patient’s response to treatment.


ED staff should respond to the call by EMS by:
 

  • Responding in a timely manner. This shows respect for the EMS crew.
  • Listening carefully.
  • If possible, assign a room number or treatment area so the crew and patient is not left waiting in a hallway when they arrive.
  • Using a professional tone. Remember, the EMS crew observed things you did not. And, the patient or family may be listening.


Upon arrival at the ED both EMS and ED staff should demonstrate professional behavior during announcement of patient arrival, history and handover of the patient. Below are some communication tips for both EMS and ED staff.

The EMS crew should:
 

  • Provide a succinct yet complete history of the patient.
  • Share any changes since the initial report.
  • Include additional information that may help the ED team.
  • Show gratitude and appreciation for the work of the ED team.
  • Transmit all information from pre-hospital EMS transports for real-time review and use, whether in print or electronically. This can be accomplished by equipping emergency departments with docking stations/printers compatible with EMS computers or by fully enabled electronic transfer to the department’s EMR system.


Upon arrival at the ED, the ED staff should:
 

  • Immediately assess each patient upon arrival and assign a bed or treatment location quickly. The EMS crew will likely be under pressure to get back in the field.
  • Keep a cordial tone and treat EMS team members with respect.
  • Be receptive to their findings and the individuals themselves.
  • Show gratitude and appreciation for the work of the EMS team. They may influence where patients receive care.


We also recommend both EMS and ED teams use Key Words at Key Times when completing care transitions. For example, the EMS team can introduce and manage up the ED caregivers by saying “Ms. Jones, you are in good hands with Dr. Smith and the ED team here.” The ED team can reciprocate by sharing “The paramedics did a great job in caring for you. We plan to continue that excellent care while you are in our emergency department.”

Our goal is to ensure a smooth and efficient transfer from prehospital care to Emergency Department care. This model of communication can decrease the risk of communication failures and improve the care we provide our patients. This also improves the working relationship between EMS and ED teams.

Sources:
"ACEP Transitions of Care Task Force Report." ACEP.org. September 1, 2012. Accessed December 6, 2015. http://www.acep.org/workarea/DownloadAsset.aspx?id=91206.

"Transfer of Patient Care Between EMS Providers and Receiving Facilities." ACEP.org. October 26, 2015. Accessed December 6, 2015. http://www.acep.org/Transfer-of-Patient-Care-Between-EMS-Providers-and-Receiving-Facilities/.

Ye K, Taylor D, Knott J, et al. Handover in the emergency department: Deficiencies and adverse effects. Emerg Med Australia. 2007;19(5):433–441.


Bob Murphy is a well-known senior leader and international healthcare presenter with more than 30 years in healthcare. His experience includes work as an EMT and Paramedic, phlebotomist, nursing assistant, registered nurse, department leader of emergency/trauma services, quality leader, risk manager, Chief Operating Officer, and hospital Chief Executive Officer. Murphy is also an attorney and is board certified in healthcare administration. Bob is now attending seminary and is pursuing a master’s degree in divinity.

Bob currently serves as a senior leader of Studer Group where he presents at healthcare conferences and seminars and coaches senior leadership teams.

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Studer Spotlight: Safe Care Transitions: Best Practices for Emergency Department to Inpatient Handovers

Posted on Thu, Jul 23, 2015
Studer Spotlight: Safe Care Transitions: Best Practices for Emergency Department to Inpatient Handovers

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Angie Esbenshade, RN, MSN

One of my colleagues, Stephanie Baker, wrote a Studer Group insight about the importance of hardwiring bedside shift report. In it, she shares the benefits and impact that handovers can have for patients and caregivers. Effective and safe patient handovers (also called care transitions) are critically important, not only between shifts on the same unit, but also between departments. Emergency Department (ED) to Inpatient (IP) handovers are essentially the same concept as bedside shift report but require some additional training and steps to effectively implement the process.

Before we discuss the “how and why” of ED to IP handovers, let’s address some of the barriers or concerns you may be thinking. We don’t want to impede the flow of patients arriving to the inpatient unit or have caregivers waiting for a nurse to come and get the patient. Caregivers are busy and may not be able to stop their work to transfer patients from one unit to the next. Also, the geography or location of the ED may be too far away for in-person patient handovers. In either case, we have seen organizations implement the process in a way that works best for their team.

For example, try using Skype or another video chat method through a laptop. If technology is a barrier, the ED caregiver can also call the inpatient nurse and discuss pertinent patient information over the phone. Information can also be faxed if that’s the only means of communication. Whatever means necessary, and within the allowed avenues of the organization, caregivers should ultimately have the opportunity to ask questions and involve the patient in this process.

Why are safe care transitions so important – for both patients and caregivers?

Care transitions are focused on the safe transfer of patients from one department or unit to another, and positively benefits both the caregivers and patients. When transitioning care from the ED to IP, the ED caregiver can ensure the patient’s needs were taken care of in the ED. The ED and IP nurses have the face-to-face chance to discuss exactly what took place in the ED and what the plan of care will look like now in inpatient.

For the inpatient caregiver, the nurse is able to confirm exactly which medications were given, what procedures were completed and that proper documentation is provided. This also improves the relationship between ED and IP caregivers.

For the patient, they become a critical part of their care plan by being involved in all discussions about their care. Caregivers reiterate that safe and quality care is their number one priority, and patients gain the opportunity to ask questions. This not only increases patient compliance with areas such as proper medication dosage, it also reduces potential sentinel events.

What does the process look like?

It’s important to remember that through ED to IP patient handovers, we don’t want the process to hinder the flow of the patient reaching their final destination. It should be a streamlined process so caregivers aren’t waiting for the IP Charge Nurse to come get the patient or waiting for the patient to be delivered by the ED nurse. Once a plan is in place, we recommend starting with the most critical patients. Some organizations implement a “swoop” mentality to transfer patients as soon as they are deemed critical. The “swoop” team will immediately identify whether the ED nurse is bringing the patient to IP or visa-versa. Then the care transition should occur at the bedside and involve the patient.

How to implement ED to IP handovers?

First we suggest starting with a team of caregivers tasked with rolling out this tactic, with the end goal of all handovers occurring at the bedside, both from ED to IP and from shift-to-shift. This team is in charge of communicating this new process with staff prior to rolling it out, which allows everyone to become familiar with the tactic and understand why it’s so important. Leaders should be involved in the process but we recommend Charge Nurses own the rollout and training since they are responsible for completing the process.

Prior to rolling out this tactic organization-wide, try piloting it with just critical patients. This allows caregivers to test the process, identify opportunities for improvement, and harvest best practices to demonstrate the effectiveness with other departments. One organization coached by Studer Group, UConn Health, recorded a webinar on this topic which outlines the steps they took to hardwire this process.

How do we measure success?

Leaders can identify successes during huddles with the core team to identify what worked well and what needs improvement during care transitions. Leaders can also ask targeted questions during Leader Rounding on Patients to see how the handover went, what they found most beneficial about the transition of their care and so on. This allows leaders to reward and recognize caregivers who are doing it well, as well as provide immediate service recovery with the patient if they didn’t feel the handover went as planned.

Another way to track effectiveness is by tracking incidents. Have you seen a decrease in incidents/sentinel events? Increase in patient safety measures? Higher levels of patient perception of care? It may not be immediate, but you should start to seem some correlation in results.

When we focus on building collaboration and partnership between ED and IP caregivers, we in turn create better environments for our patients to receive care. It also generates evidence that we’re able to adapt to change for the better of our patients and organization as a whole. As difficult as it may seem at times, we must constantly strive to deliver the highest levels of quality and safe care.

Additional Resources:

Angie Esbenshade, RN, MSN, has over 17 years of clinical nursing and administrative experience in emergency, trauma, and critical care. She is a graduate of Pensacola Christian College, has a Bachelor’s Degree in Nursing and a dual Master’s degree in Nursing and Business Administration and is a certified nurse executive through the American Nurses Credentialing Center.

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