A Survey on Handoff Communication Between Paramedics and Physicians During the Care of Critically-ill PatientsWill Enochs1, Emily Hillman1,2, Steve Simon1, Charles Inboriboon1,2, Christopher Morrison1,2

1UMKC School of Medicine, 2Truman Medical Center

INTRODUCTION• One of the most common causes of medical error is poor

communication.1 • Patient handoffs or transitions in care have been identified as an

area of communication prone to errors.2 • The transition of care (ToC) from paramedics to physicians during

the care of critically ill patients is an important aspect of patient care that is inherently prone to miscommunication.3

• There are few studies exploring emergency department (ED) paramedic-physician handoff communication during emergent situations. Additionally, there are no standardized ToC models for emergent handoff situations.

• The purpose of this study is to explore paramedic-physician handoff communication from the perspectives of both paramedics and physicians to identify key characteristics of handoff communication and factors that influence the quality of handoff communication.

METHODS• REDCap was utilized to create an anonymous online survey tool

adapted from a previously validated tool used in research on ToC in the ED.4

• Participants for the survey were selected in a single-stage convenience sampling and stratified according to subgroups: Emergency medicine (EM) residents, pediatric EM fellows, practicing emergency physicians (both academic and community), EMS medical directors, and paramedics.

• All participants work within the Kansas City Metropolitan Area• The surveys of EM residents were distributed via their program

director. The surveys of practicing emergency physicians were distributed via their department chair or medical director. The surveys of the paramedics were distributed via their EMS medical directors. The medical directors and fellows were directly contacted for participation.

RESULTS• 91 physicians and 34 paramedics completed a total of 125 surveys. • The majority (85%) of respondents felt that handoff communication

during emergent situations needs improvement.• Of those surveyed 48% receive formal training on handoff

communication during ToC of critically-ill patients. Only 11% are formally assessed on handoff proficiency.

• Residents were more likely than attending physicians to receive formal handoff training (p < 0.001). Respondents with nine or less years of experience were more likely to have received formal training than those with 10 or more years of experience (p < 0.004).

• The majority of respondents do not use a structured handoff system for paramedic-to-physician ToC (82%).

• The relative ranking of the importance of logistical parameters was remarkably consistent between paramedics, residents/fellows, and attendings/medical directors

• There was strong agreement between the three subgroups on the importance of informational parameters with three exceptions: paramedics felt that medication history, patient initial location, and pre-hospital course were less important than the residents/fellows and the attendings/medical directors.

• Self-perceived competence with giving or receiving handoffs was similar between subgroups and based on years of experience.

CONCLUSIONThe ToC between physicians and paramedics in emergent situations could use improvement. Formal training on handoff communication is not ubiquitous and structured assessments are not being performed. Current trainees and recent graduates are more likely to have received formal handoff training, indicating that perhaps training programs are starting to incorporate handoff communication into the curriculum. It is unknown whether this training occurs as part of an interprofessional experience or in isolation. The majority of respondents do not use a structured handoff system for the ToC of a critically-ill patient but feel that having one would improve communication. Important logistical and informational parameters were identified to potentially guide the development of a ToC algorithm or handoff tool. There was general agreement between the subgroups on the importance of certain informational and logistical parameters that influence handoff communication. Interviews with physicians and paramedics as part of a sequential mixed methods approach would lead to a better understanding paramedic-physician handoff communication. By combining both quantitative and qualitative data a better understanding of the research problem will emerge and a ToC algorithm can be proposed. Ideally the algorithm will be used create active learning opportunities and a method for assessment. Further studies can then focus on whether formal training can improve handoff communication and thus patient care.

CREDITS/DISCLOSURE/REFERENCES1. Solet DJ, Norvell M, Rutan G, and Frankel, R. Lost in Translation: Challenges and Opportunities

in Physician-to-Physician Communication During Patient Handoffs. Academic Medicine. 2005;80(12):1094-1099.

2. The Joint Commission Center for Transforming Healthcare. Improving Transitions of Care: Hand-off Communications. (2013). Accessed 4 July 2013.

3. Scott LA, Brice JH, Baker CC, and Shen P. An Analysis of Paramedic Verbal Reports to Physicians in the Emergency Department Trauma Room. Prehospital Emergency Care. 2003;7:247-251.

4. Kessler, C MD, MPHE, et al. An Algorithm for Transition of Care in the Emergency Department. Academic Emergency Medicine. 2013;20(6):605-610.

None Written template or aide

Mnemonics Computer/Electronic template

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Tools Used to Assist with Handoffs