Background
Aim
Methods
Design
Setting
Pre-hospital specialist teams
Questionnaire development
Question/statement | Scale/Unit of measurement |
---|---|
• Perceived effectiveness of handover | 1 – not at all effective to 5 - very effective |
• Confidence that you have provided all essential information during handover | 1 – not at all confident to 5 – very confident |
• Confidence that you have received all essential information during handover | |
• Importance of patient involvement in handover process | 1- not important to 5 – very important |
• Importance of a structured handover | |
• Importance on mutually agreeing a handover time and location | |
• Perceived essential variables for handover | List of variables |
• Recording and delivery of information | |
• Preferred mnemonic for prehospital handover | |
• How professional acknowledges receipt of information | |
• Acknowledging receipt of information | 1 – never to 5 – always |
• How often the patient is involved in the handover process | |
• Barriers to effective handover | |
• Repeating information during handover | |
• Barriers to effective handover (how often they impact) | |
• Difficulty in finding time to prepare and deliver handover | 1 – very difficult to 5 – very easy |
• Timing of handover | Time in minutes |
-
SAS ambulance clinicians (road ambulance crew) – Paramedic and Technician led.
-
Emergency Medical Retrieval Service/Tayside Trauma Team/Lothian Medic One clinicians – Physician led.
-
Bristows Search and Rescue Aircrew – paramedic led.
-
SAS Helimed aircrew (Inverness, Glasgow and Perth) – paramedic led.
-
BASICS Scotland responders – mix of Physician, Paramedic and Nurse led.
-
SAS Special Operations Response Teams Ambulance Clinicians – Paramedic and Technician led.
Data definitions
Mnemonic | Breakdown |
---|---|
ASHICE | Age, Sex, History, Injuries, Condition, Expected Time of Arrival |
DeMIST | DeMIST – Patient Demographics, Injuries Sustained, Symptoms and Signs, Treatments given |
MIST | Mechanism of Injury, Injuries Sustained or suspected, Signs – vital signs, Treatments initiated (and timing) |
SBAR | Situation, Background, Assessment, Recommendations |
IMIST AMBO | Identification, Mechanism/Medical complaint, Injuries/Relevant info, Signs (vital), Treatment and Trends, Allergies, Medication, Background History, Other info |
ATMIST | Age [inc. name], Time of onset, Medical Complaint/History or Mechanism, Investigations/Injuries, Signs, Treatment |
De MIST | Patient Demographics, Mechanism, Injuries sustained or expected, Signs – vital signs, Treatment |
SOAP | Subjective information, Objective Information, Assessment, Pain |
Study sample and recruitment
Data analysis
Results
Used and preferred mnemonics
Perceived effectiveness and confidence in existing handover practices
Perceived essential variables for handover
Barriers to effective handover
Variable measured (listed in order of frequency) | All Mean (Standard Deviation) | Road Crews (Standard Deviation) | Specialist Teams | All Median (IQR) | Road Crews (n = 116) Median (IQR) | Specialist Teams Median (IQR) | Difference between Groups p value (U) |
---|---|---|---|---|---|---|---|
Interruptions | 3.26 (.813) | 3.21 (.818) | 3.35 (.801) | 3.00 (2–3) | 3 (2–3) | 3 (3–4) | .224 |
Variability in handover mnemonic | 3.09 (.953) | 2.97 (.950) | 3.28 (.929) | 3.00 (2–4) | 3 (2–4) | 3 (3–4) |
.034*
|
Lack of co-ordination between responders | 3.09 (.761) | 3.04 (.773) | 3.16 (.741) | 3.00 (3–4) | 3 (3–4) | 3 (3–4) | .222 |
Lack of structured process | 3.07 (.879) | 2.95 (.863) | 3.26 (.877) | 3.00 (2–4) | 3 (2–4) | 3 (3–4) |
.022*
|
Lack of clear professional lead | 3.01 (.813) | 2.94 (.816) | 3.11 (.804) | 3.00 (2–4) | 3 (2–3) | 3 (3–4) | .141 |
Poor verbal communication | 2.97 (.856) | 2.90 (.882) | 3.08 (.807) | 3.00 (2–3) | 3 (2–3) | 3 (3–4) | .090 |
Absence of written clinical information | 2.96 (.844) | 2.91 (.875) | 3.05 (.792) | 3.00 (2–4) | 3 (2–3) | 3 (2.75–4) | .228 |
Hazards relating to the TYPE of incident | 2.75 (.860) | 2.66 (.814) | 2.89 (.915) | 3.00 (2–4) | 3 (2–3) | 3 (2–4) | .064 |
Environmental hazards | 2.74 (.791) | 2.62 (.798) | 2.93 (.746) | 3.00 (2–3) | 3 (2–3) | 3 (2–3) |
.004*
|
Multi-agency involvement: too many | 2.74 (.853) | 2.71 (.856) | 2.77 (.853) | 3.00 (2–3) | 3 (2–3) | 3 (2–3) | .943 |
Difficulties in triage priorities during multi-casualty incident | 2.67 (.795) | 2.59 (.807) | 2.79 (.763) | 3.00 (2–3) | 3 (2–3) | 3 (2–3) | .204 |
Inappropriate location of handover | 2.54 (.784) | 2.46 (.832) | 2.67 (.853) | 3.00 (2–3) | 3 (2–3) | 3 (2–3) | .106 |
Lack of professionalism | 2.54 (.872) | 2.58 (.886) | 2.49 (.852) | 2.00 (2–3) | 2 (2–3) | 2 (2–3) | .673 |
Handover timing too early | 2.48 (.762) | 2.43 (.829) | 2.54 (.645) | 2.00 (2–3) | 2 (2–3) | 3 (2–3) | .354 |
Handover timing too late | 2.40 (.783) | 2.33 (.814) | 2.50 (.726) | 2.00 (2–3) | 2 (2–3) | 2.5 (2–3) | .117 |