Faculty of Medicine, University of Toronto, Toronto, ON.
Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON.
CJEM. 2020 Sep;22(S2):S21-S29. doi: 10.1017/cem.2019.438.
There has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be beneficial for trauma team performance.
Data were prospectively collected over a nine-week period by a trained observer at a Canadian level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders and EMS according to a bidirectional Likert scale.
79 formal verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Of all questions asked, 35% were questioning previously given information. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking. There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders.
We have identified the need to standardize handover due to poor information content, a lack of structure and active listening, information repetition, and discordant expectations between team members. These data will guide the development of a co-constructed framework integrating the perspectives of all team members.
对于从紧急医疗服务（EMS）到创伤团队的交接，评估有限。我们试图描述这些交接实践，以确定改进的领域，并确定交接标准化是否可能有利于创伤团队的表现。
在加拿大一级创伤中心，一名经过培训的观察员在九周的时间内进行了前瞻性数据收集。使用随机时间表捕获了广泛的代表性交接。收集的数据包括交接持续时间、交接结构和共享信息等结果指标，以及来自创伤团队的问题和中断等过程指标，并根据双向李克特量表评估护士、创伤团队领导和 EMS 对交接的看法。
观察到 79 次正式的口头交接。关于气道（存在 22%）、呼吸（54%）、药物（59%）和过敏（54%）的信息经常缺失。交接结构除了识别顺序和损伤机制外，缺乏一致性。所有提出的问题中，有 35%是对之前提供的信息提出的质疑。大多数交接（61%）涉及团队成员之间的平行对话，而 EMS 在发言时。EMS 自我评估的交接和护士和创伤团队领导感知的质量之间存在统计学显著差异。
由于信息内容差、缺乏结构和主动倾听、信息重复以及团队成员之间的期望不一致，我们需要标准化交接。这些数据将指导制定一个共同构建的框架，整合所有团队成员的观点。
