PHOENIX — Care transitions, also known as patient handoffs, are the physical movement of a patient from one healthcare provider to another, as well as the exchange or transmission of actionable and understandable information about the patient. Lee Varner, Center for Patient Safety director of EMS services, described the importance of transitions of care as critical to patient safety in a session at the 2018 Pinnacle EMS leadership conference.
Transitions of care don’t just happen in the emergency department. EMS providers regularly pick up and drop off patients at physician offices, dialysis centers, jails, ambulatory surgery centers and free-standing emergency departments. Each of these locations is likely to have unique patient care records and staffing that can complicate communication about a patient. Leaders must take steps to protect patient safety and avoid potentially deadly medical errors by systematically improving communication during these events.
The Center of Patient Safety has a validated survey tool to assess an EMS organization’s culture of safety. The EMS Safety Culture Assessment is administered by the CPS and is also available through open source for organizations to use on their own.
Twenty-five organizations have already completed the survey and Varner is seeking more organization to participate. Several trends are emerging in the initial aggregated data set. According to Varner, EMS providers score well in training and teamwork, but report a workplace environment that is often punitive when errors are reported.
Memorable quotes on transitions of care
Varner is a long-time advocate for patient safety. He described his own experience as a new EMT struggling to interact with a physician and how he has learned about safety culture from other high-risk occupations and healthcare sectors. Here are four memorable quotes from Varner’s presentation.
“There is still misconception of what patient safety is in EMS.”
“Patient safety is a discipline in the healthcare sector that applies safety science methods toward the goal of achieving a trustworthy system of healthcare delivery.”
“Transitions of care have been identified by the Joint Commission and World Health Organization as an area of concern.”
“Culture of safety is the personality of workplace. It’s a combination of many different things that need to be nurtured and supported.”
Top takeaways on transitions of care
Here are four takeaways on transitions of care from Varner’s presentation.
1. Patient safety matters
Varner explained the importance of patient safety and why it matters to providers and patients. Communication problems and failures are a leading cause of adverse events and also lead to delays in life-saving interventions. Varner specifically mentioned the importance of timely and effective information transmission for STEMI, stroke and trauma patients.
An organization’s culture of safety needs to be grown. Punishment and poor teamwork can damage a culture. Teamwork, mutual support and trust nurture an organization’s culture safety.
2. Use training to set expectations and experience
Patient handoffs can and should be practiced and improved with classroom education and hands-on training. The critical information to transmit or receive about a patient can be incorporated into case discussions.
High-fidelity patient simulation should also incorporate a transition of care. Use video debrief to analyze the hand-off report and opportunities for improvement.
In any training, as well as real life, Varner recommended use of a standardized process, like MIST or I-PASS, to transition patient care. Varner recommended that those processes are developed and validated locally.
3. Acknowledge and plan for overcoming communication barriers
Communication barriers often exist in transitions of care. Varner explained how each of these barriers can complicate communication and increase risk for an adverse event:
- Unclear expectations.
- Time compression.
- Confusing factors.
- Authority gradients.
- Interdisciplinary strain.
- Critical information requiring a decision.
- Competing technology such as smartphones.
Review this list of barriers in your next company training or shift roll call. Ask EMS providers how these barriers manifest in transitions of care and how they can be overcome or avoided.
4. Productively use the “golden minute”
An EMT or paramedic usually has less than a minute, the “golden minute,” to handoff a patient to a nurse or physician. It’s essential to wisely and efficiently use that time to share information with a standardized tool or process.
Learn more about patient safety and transitions of care
EMS Forward 360 is a recently launched campaign from the Center of Patient Safety. Varner also recommended the Strategy for a National EMS Culture of Safety as an important resource for EMS leaders.
To learn more about patient handoffs and reporting check out these EMS1 articles:
- How to improve EMS patient handoffs at emergency department
- Capnography best practices to improve patient handoff reports
- ‘Do it for Drew’ by checking and rechecking tube placement
- How to use a chronological approach for ePCR narratives
- Why patient hand-offs are important to successful care
- Inside EMS Podcast: How to perfect your patient handoff report
- 5 easy ways to improve your PCR writing
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