The Impact of Professionalism on Transfer of Care to the Emergency Department.

BACKGROUND

Patient care transfer from Emergency Medical Services (EMS) to the emergency department (ED) providers is a transition point where there are high rates of information degradation and variability in perceptions of handoff quality.

OBJECTIVE

To evaluate EMS and ED provider perceptions of information transfer compared to an external observer's objective assessment.

METHODS

This evaluation is a review of a quality-improvement database at an academic trauma center. EMS to ED patient transfers were attended by trained external observers who recorded communicated data and evaluated provider professionalism. After handoff, EMS and ED staff rated their own perceptions of the transfer.

RESULTS

Trained observers evaluated 1091 patient transfers. The perceived transfer quality was similar between EMS and ED staff, while trained observer ratings were different from EMS (odds ratio [OR] = 13.1; p < 0.001) and ED staff perceptions (OR = 20.2; p < 0.001). The EMS and ED staff perceptions were not influenced by absence of vital signs or demographics, but were affected by the perceived provider professionalism (EMS: OR = 2.4; p < 0.001; ED staff: OR = 1.5; p = 0.03).

CONCLUSIONS

This project is the largest evaluation of perceptions of ED transfers of care. During these transfers, significant key clinical information was not passed from EMS to ED staff. This did not have an association with EMS and ED staff transfer perception. Professionalism did affect attitudes concerning quality transfers of are. Future studies should focus on methods to improve information transfer while maximizing the subjective qualities of professional EMS-ED interactions.