Handover from paramedics: observations and emergency department clinician perceptions

Abstract

Objectives: 1. To evaluate emergency clinician attitudes towards handover from prehospital paramedics. 2. To determine the content and methods of paramedic handover delivery to emergency clinicians.

Methods: Exploratory study comprising questionnaire of emergency clinicians and observation of paramedic-to-emergency clinician handover with associated survey at an adult tertiary referral hospital with approximately 12,000 ambulance arrivals of 37,000 annual attendances.

Results: Emergency staff found handover from paramedics on patient conditions relevant, especially for altered consciousness (94%, 95% CI 83.5-98.6), trauma (90%, 95% CI 82.0-98.4) and chest pain (88%, 95% CI 79.0-97.0), but less so for behavioural disturbance (67%, 95% CI 53.7-79.5). A total of 621 handovers from 311 ambulance arrivals were observed. Most arrivals (81%, 95% CI 76.4-85.4) were not preceded by prehospital communication. Paramedics handed over twice 91% of the time (95% CI 88.2-94.4). Doctors received direct paramedic handover for 12% (95% CI 8.0-15.1) of ambulance arrivals, including 19 team handovers, whereas triage nurses took 97% (95% CI 95.6-99.2) and attending nurses, 91% (95% CI 87.5-93.9). Fifty per cent (95% CI 42.7-57.3) of emergency clinicians referred to ambulance sheets. Handover information was perceived to be useful and accurate in more than 80% of instances. Verbal handover occurred before ambulance sheet completion for 78% (95% CI 73.5-82.7).

Conclusion: Although there is satisfaction in paramedic handover, prehospital notification and emergency physician contact with paramedics is uncommon for low acuity patients, who constitute the majority of ambulance attendances and hospital admissions. Scope for improved direct doctor-paramedic communication exists.