Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis.
CJEM · 2023-04-23 · Observational study
Abstract
OBJECTIVE: Patient handover between paramedics and the trauma team is vulnerable to communication errors that may adversely affect patient care. This study assesses the feasibility of a handover tool, IMIST-AMBO (acronym of categories), implementation in the trauma bay and evaluates the degree to which it improves handover metrics. METHODS: This is a prospective observational cohort study conducted at Canada's largest level-one trauma center. Feasibility of the tool implementation and improvement in handover metrics were assessed. Strategies for implementation included distribution of an educational video and posters, and point-of-care reminders in the trauma bay. Two reviewers independently assessed video recordings of handovers to evaluate handover metrics. Findings were compared to data obtained during a knowledge gap analysis conducted prior to the initiation of this study at the same institution. RESULTS: Over 13 weeks (August to November 2020), 140 videos were recorded, of which 80 used the IMIST-AMBO tool (compliance of 57%). Paramedic adherence to the handover structure occurred in 70.4% of cases, with greater adherence to the IMIST (82.2%) compared to the AMBO (47.1%) section. The mean (± standard deviation) handover duration was shorter (1 min:58 s ± 0:44 s during implementation vs. 2 min:47 s ± 1:14 s pre-implementation, [p < 0.001]). Frequency of parallel conversations and informal handovers improved (61% to 30% and 65% to 13%, [p < 0.001], respectively). Interruptions during the handover decreased from 3.05 (± 1.95) to 1.5 (± 1.7), p < 0.001. The tool was received favorably among study participants. CONCLUSION: The IMIST-AMBO tool reduced the frequency of interruptions, parallel conversations, and informal handovers during paramedic-trauma team handovers at our institution. The quality and amount of information communicated per handover improved, all with a decrease in handover duration. The IMIST-AMBO tool may be applied to other trauma centers across Canada, or more broadly on an international scale.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Communication & handover · Implementation · Paramedics & EMTs · Time intervals
Related articles
- Design and trial of a new ambulance-to-emergency department handover protocol: 'IMIST-AMBO'. (BMJ Qual Saf, 2012)
- Assessing clinical handover between paramedics and the trauma team. (Injury, 2010)
- Implementation of a prealert to improve in-hospital treatment of anticoagulant-associated strokes: analysis of a prehospital pathway change in a large UK centralised acute stroke system. (BMJ Open Qual, 2020)
- A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study. (Scand J Trauma Resusc Emerg Med, 2015)
- Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report. (BMJ Open Qual, 2025)
- Speech recognition technology in prehospital documentation: A scoping review. (Int J Med Inform, 2025)