Lost information during the handover of critically injured trauma patients: A mixed-methods study

Tanya Zakrison, Brittany Rosenbloom, Amanda McFarlan, Aleksandra Jovicic, Sophie Soklaridis, Casey Allen, Carl I Schulman, Nicholas Namias, Sandro Rizoli

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. Methods A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. Results Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. Conclusion Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover.

Original languageEnglish (US)
Pages (from-to)929-936
Number of pages8
JournalBMJ Quality and Safety
Volume25
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Intensive Care Units
Hospital Emergency Service
Wounds and Injuries
Nurses
Physicians
Safety Management
Trauma Centers
Emergency Medical Services
Patient Safety
Nonparametric Statistics
Focus Groups
Communication
Interviews
Research

Keywords

  • Checklists
  • Critical care
  • Emergency department
  • Hand-off
  • Team training

ASJC Scopus subject areas

  • Health Policy

Cite this

Zakrison, T., Rosenbloom, B., McFarlan, A., Jovicic, A., Soklaridis, S., Allen, C., ... Rizoli, S. (2016). Lost information during the handover of critically injured trauma patients: A mixed-methods study. BMJ Quality and Safety, 25(12), 929-936. https://doi.org/10.1136/bmjqs-2014-003903

Lost information during the handover of critically injured trauma patients : A mixed-methods study. / Zakrison, Tanya; Rosenbloom, Brittany; McFarlan, Amanda; Jovicic, Aleksandra; Soklaridis, Sophie; Allen, Casey; Schulman, Carl I; Namias, Nicholas; Rizoli, Sandro.

In: BMJ Quality and Safety, Vol. 25, No. 12, 01.12.2016, p. 929-936.

Research output: Contribution to journalArticle

Zakrison, Tanya ; Rosenbloom, Brittany ; McFarlan, Amanda ; Jovicic, Aleksandra ; Soklaridis, Sophie ; Allen, Casey ; Schulman, Carl I ; Namias, Nicholas ; Rizoli, Sandro. / Lost information during the handover of critically injured trauma patients : A mixed-methods study. In: BMJ Quality and Safety. 2016 ; Vol. 25, No. 12. pp. 929-936.
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N2 - Background Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. Methods A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. Results Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. Conclusion Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover.

AB - Background Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. Methods A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. Results Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. Conclusion Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover.

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