Why patient hand-offs are important to successful care

A 67-year-old male patient, whose chief compliant is a fever, hypotension and weakness, is left at the emergency department by EMS. A verbal report is given by EMS to the nursing staff.

After the EMS team leaves, there are questions regarding the patient's history, allergies, medications and the events leading up to the illness as septic shock is suspected. The electronic EMS chart is not available, nor is there a copy of the verbal report from EMS.

The ED staff must track down the EMS crew for more information. This leads to wasted time and resources during a potentially critical situation.

Knowledge and information is said to be power, but for patient safety it is vital. Every day patient hand offs occur where valuable information is lost or not shared.

This has become even more of an issue as many health care organizations, EMS included, have transitioned from paper charts to electronic health records and there is a lack of interoperability. Therefore, the Center for Patient Safety is adding transitions of care to this report due to the potential for data/information to be lost or missing.

Standardize hand-off report
Patient hand-offs can be thought of as an intersection where critical information is shared about patients between providers. These transitions occur in a variety of settings and many times the actual hand-off/report is not viewed as a critical step.

However, as illustrated above, this is a vital piece of the patients’ care and can help determine the next steps. Anytime a transition of care takes place, EMS providers need to ensure all the information is shared in a succinct, standardized manner.

One such approach taken from TeamSTEPPS and endorsed by the Agency for Health Research and Quality is the SBAR approach:

Situation
What is going on with the patient"

Background
What is the clinical background/context"

Assessment
What do I think the problem is"

Recommendation
What would I recommend"

The SBAR approach provides a framework for team members to effectively communicate information to one another. It is an easy to remember and easy-to-use tool for framing any conversation requiring a clinician’s immediate attention and action in any setting. Standardizing the transition of care helps to ensure the patient's care is smooth, no data/information is lost and improves patient safety.

Eunice Halverson, MA, CPS Patient Safety Specialist, states, "Patient hand-offs from prehospital providers to the hospital providers is one of the most important elements of successful care for patients with serious injuries or illnesses. Use of a standardized communication structure is key to a successful hand-off. Effective and complete communication enhances patient safety!"

An EMS time out, using the MIST reporting format, is an example of a tool that can be used for a patient hand-off:

M: Age/sex, mechanism or medical complaint

I: Injuries or inspections

S: Vital signs

T: Treatment

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