A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 2015-04-16 · Quasi-experimental
Abstract
OBJECTIVE: To standardize patient handover in the chain of emergency care a handover guideline was developed. The main guideline recommendation is to use the DeMIST model (Demographics, Mechanism of Injury/illness, Injury/Illness, Signs, Treatment given) to structure pre-hospital notification and handover. To benefit from the new guideline, guideline adherence is necessary. As adherence to guidelines in emergency care settings is variable, there is a need to systematically implement the new guideline. For implementation of the guideline we developed a e-learning program tailored to influencing factors. The aim of the study was to evaluate the effectiveness of this e-learning program to improve emergency care professionals' adherence to the handover guideline during pre-hospital notification and handover in the chain of emergency medical service (EMS), emergency medical dispatch (EMD), and emergency department (ED). METHODS: A prospective pre-test post-test study was conducted. The intervention was a tailored e-learning program that was offered to ambulance crew and emergency medical dispatchers (n=88). Data on adherence included pre-hospital notifications and handovers and were collected through observations and audiotapes before and after the e-learning program. Data were analyzed using X(2)-tests and t-tests. RESULTS: In total, 78/88 (88.6%) professionals followed the e-learning program. During pre- and post-test, 146 and 169 handovers were observed respectively. After the e-learning program, no significant difference in the number of handovers with the DeMIST model (77.9% vs. 73.1%, p=.319) and the number of handovers with the correct sequence of the DeMIST model (69.9% vs. 70.5%, p=.159) existed. During the handover, the number of questions by ED staff and interruptions significantly increased from 49.0% to 68.9% and from 15.2% to 52.7% respectively (both p=.000). Most handovers were performed after patient transfer, this did not change after the intervention (p=.167). The number of handovers where information was documented during handover slightly increased from 26.9% to 29.3% (p=.632). CONCLUSIONS: The tailored e-learning program did not improve adherence to a handover guideline in the chain of emergency care. Results show a relatively high baseline adherence rate to usage and correct sequence of the DeMIST model. Improvements in the handover process can be made on the documentation of information during handover, the number of interruptions and questions, and the handover moment.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Communication & handover · Dispatchers & call takers · Implementation · Paramedics & EMTs
Related articles
- Design and trial of a new ambulance-to-emergency department handover protocol: 'IMIST-AMBO'. (BMJ Qual Saf, 2012)
- Factors Impacting Treatment of Out-of-Hospital Cardiac Arrest: A Qualitative Study of Emergency Responders. (J Am Heart Assoc, 2023)
- Insights into the implementation and operation of a novel paramedic long-term care program. (Prehosp Emerg Care, 2014)
- Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis. (CJEM, 2023)
- Exploring the use of pre-hospital pre-alerts and their impact on patients, Ambulance Service and Emergency Department staff: a mixed-methods study. (Health Soc Care Deliv Res, 2026)
- Arriving Safely: Decreasing Rapid Escalations in Care for Incoming Transported Pediatric Patients. (Pediatr Qual Saf, 2023)