Communication between pre-hospital and intra-hospital emergency medical services: literature review

Souza, Melorie Marano de; Xavier, Allan Corrêa; Araújo, Cássia Amorim Rodrigues; Pereira, Eric Rosa; Duarte, Sabrina da Costa Machado; Valladares Broca, Priscilla

doi:10.1590/0034-7167-2019-0817

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 73 (suppl 6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0817 copy

Communication between pre-hospital and intra-hospital emergency medical services: literature review

La comunicación entre los servicios médicos de emergencia pre-hospitalaria e intra-hospitalaria revisión de literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze, according to the scientific literature, communication strategies in the transfer of cases between pre-hospital and in-hospital services and their contributions to patient safety.

Methods:

this is a literature review study, that is, one that aims to gather and synthesize research results on the subject in a systematic and orderly manner.

Results:

ten articles were published, published between 2010 and 2018, and two points of discussion emerged: use of mnemonics; and barriers to transferring a case.

Conclusions:

studies point to the need to standardize the case transfer process, as well as integrative training of professionals, regular assessment of the teams involved in emergency medical services and the need for research on the subject.

Descriptors:
Communication; Emergency Medical Services; Ambulance; Transfer of Responsibility by the Patient; Review

Article title	Year Country	Outline/ number of participants	Recommendations	Conclusion	Level of evidence
The satisfaction regarding handovers between ambulance and emergency department nurses: an observational study Handover of Patients From Prehospital Emergency Services to Emergency Departments⁽¹⁵15 Hovenkamp GT. The satisfaction regarding handovers between ambulance and emergency department nurses: an observational study. Scand J Trauma ResuscEmerg Med. 2018;10;26(1):78. doi: 10.1186/s13049-018-0545-7 https://doi.org/10.1186/s13049-018-0545-... ⁾	2018 Netherlands	Quantitative prospective observational study	Further research to target the quality of transfers can focus on the use of a standardized protocol.	The satisfaction of ambulance nurses is mainly affected by the waiting time and the presence of a doctor, while the satisfaction of nurses in the Emergency Department is mainly affected by the use of delivery instruments.	2
Handover of Patients From Prehospital Emergency Services to Emergency Departments: a qualitative analysis based on experiences of nurses⁽¹⁶16 Sanjuan A. Handover of patients from prehospital emergency services to emergency departments: a qualitative analysis based on experiences of nurses. J Nurs Care Qual. 2018;34(2):169-74. doi: 10.1097/NCQ. 0000000000000351 https://doi.org/10.1097/NCQ. 00000000000... ⁾	2018 Spain	Qualitative descriptive / 12 nurses	To perform proper patient transfer, the professional must identify himself to the patient's receiving nurse and pass on patient information in the following order: patient identification, reason for referral, past medical history and baseline, if they know each other, procedures performed before arrival and patient response to treatment. The emergency nurse must confirm the correct receipt of all information, repeating it or asking questions and asking for clarification as needed. Verbal communication should always be copied with written material provided by the nurse in the pre-hospital emergency medical service.	The essential information to be included in patient transfers is: the reason for referral; previous history, including any information relevant to the case; allergies to medications and procedures performed with an emphasis on medication administration; and response to treatment.	4
Perspectives of Patient Handover among Paramedics and Emergency Department Members; a Qualitative Study⁽¹⁷17 Kalyani MN, Fereidoun Z, Sarvestani RS, Shirazi ZH, Taghinezhad A. Perspectives of patient handover among paramedics and emergency department members; a qualitative study. Emerg (Tehran) [Internet]. 2017 [2019 Jun 06];5(1):e76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703753/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2017 Iran	Descriptive exploratory / 25 professionals from pre-hospital and in-hospital emergency services, including paramedics and nurses	Patient transfer is a skill that requires education and practice; therefore, in this sense, in-service education is a priority.	Designing an appropriate environment, recruiting appropriate labor, providing adequate equipment and clarifying expectations are some strategies to improve patient delivery between pre-hospital and in-hospital services.	4
A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients⁽¹⁸18 Flynn D, Francis R, Robalino S, Lally J, Snooks H, Rodgers H, et al. A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. BMC Emerg Med. 2017;17(1):5. doi: 10.1186 / s12873-017-0118-5 https://doi.org/10.1186 / s12873-017-011... ⁾	2017 United Kingdom	Systematic review / no article responded to the objective. 36 studies in the full text phase were selected for narrative review.	Due to the nature of the studies identified, no strong recommendations can be made about changing the transfer or post admission functions of ambulance paramedics to the hospital for patients with critical time conditions.	A "new wave" of paramedical research is needed to inform the design of transfer and feedback processes with cost effective and health impact resulting from improved communication and interprofessional sharing of clinical skills.	4
A national research agenda for pre-hospital emergency medical services in the Netherlands: a Delphi-study⁽¹⁹19 Glind IVD. A national research agenda for pre-hospital emergency medical services in the Netherlands: a Delphi-study. Scand J Trauma ResuscEmerg Med. 2016;24: 2. doi: 10.1186/s13049-015-0195-y https://doi.org/10.1186/s13049-015-0195-... ⁾	2016 Netherlands	Survey/ 62 specialists in the field of pre-hospital emergency services	Qualitative data collection is recommended for researchers when they want to define a research agenda.	Nine topics were defined as priorities in the research agenda of pre-hospital emergency services: Non-transportation to the hospital ⁽highest ranked⁾; Performance measures for quality of care; Delivery / registration / exchange of patient data; Care and replacement of tasks; Screening; Assessment of acute neurological signs and symptoms; Protocols and adherence to the protocol; Immobilization; and Open / protect by air.	6
Emergency Care Handover ⁽ECHO study⁾ across care boundaries: the need for joint decision making and consideration of psychosocial history⁽²⁰20 Sujan MA. Emergency Care Handover (ECHO study) across care boundaries: the need for joint decision making and consideration of psychosocial history. Emerg Med J. 2015;32(2):112-8. doi: 10.1136/emermed-2013-202977 https://doi.org/10.1136/emermed-2013-202... ⁾	2015 United Kingdom	Descriptive exploratory / n = 203 case transfer conversations	The standardization of transfer needs to accommodate collaborative aspects and must incorporate the communication of information relevant to the patient's social and psychological needs, in order to establish appropriate care arrangements at the first opportunity.	The transfer of a case can involve both descriptive conversations aimed at transferring information and collaborative conversations aimed at joint decision-making.	4
Managing competing organizational priorities in clinical handover across organizational boundaries⁽²¹21 Sujan MA. Managing competing organizational priorities in clinical handover across organizational boundaries. J Health Serv Res Policy. 2014;20(1-Suppl):17-25. doi: 10.1177/1355819614560449 https://doi.org/10.1177/1355819614560449... ⁾	2015 United Kingdom	Descriptive exploratory / 39 professionals working in pre-hospital and in-hospital emergency medical services	Organizations and regulators may consider determining and implementing quality indicators to monitor the effectiveness of interorganizational collaboration. These quality indicators can include patient-focused outcome measures that reflect the entire path, as well as specific process measures across borders.	The transfer problems that professionals experience in their daily clinical practice are often associated with organizational factors, such as managing patient flows and time-related performance goals.	4
Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study⁽²²22 Leijen-zeelenberg JEV. Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study. BMC Health Serv Res. 2014;3;14:149. doi: 10.1186/1472-6963-14-149 https://doi.org/10.1186/1472-6963-14-149... ⁾	2014 Netherlands	Multiple case study / 6 cases	Future efforts to redesign information and feedback must begin with the establishment of a sense of urgency, and the "unlearning" of a routine should receive the same effort as learning a new one.	In general, the results of the study show a series of perceived barriers to the implementation of a redesign of information transfer and feedback in acute care. Most barriers were related to organizational routines and lack of a sense of urgency to change the practice.	4
Usage of documented pre-hospital observations in secondary care: a questionnaire study and retrospective comparison of records⁽²³23 Knutsen GO, Fredriksen K. Usage of documented pre-hospital observations in secondary care: a questionnaire study and retrospective comparison of records. Scand J Trauma Resusc Emerg Med. 2013; 1;21:13. doi: 10.1186/1757-7241-21-13 https://doi.org/10.1186/1757-7241-21-13... ⁾	2013 Norway	Cross-sectional questionnaire and retrospective study / n = 29 professionals of the in-hospital emergency services and n = 501 records	Several issues must be investigated: for example, the clinical consequences of omitting information and the flow of verbal information and its use in clinical decisions.	Professional registrars in the Emergency Department prefer verbal case transfer and handwritten prehospital reports based on clinical information; and hardly ever use digitized report forms. They also perceive other doctors' clinical information as more important than information from ambulance teams. Less than half of the potentially important information documented in the available pre-hospital notes is transferred to hospital records.	4
Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members⁽²⁴24 Evans SM, Murray A, Patrick I, Fitzgerald M, Smith S, Cameron P. Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members. Qual Saf Health Care. 2010;19(6):e57. doi: 10.1136/qshc.2009.039073. https://doi.org/10.1136/qshc.2009.039073... ⁾	2010 Australia	Descriptive exploratory / 27 professionals among paramedics and members of the emergency team	Provide frontline doctors with tools and techniques to improve their ability to collect information with minimal burden and deliver it with seamless integration between services in order to improve results.	Respondents stated that an effective patient transfer was performed in a succinct and structured manner and contained only vital data necessary to direct immediate treatment.	4

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[1] Corresponding author: Priscilla Valladares Broca. E-mail: priscillabroca@gmail.com