title: Pre-hospital/emergency department handover in Italy.
abstract: In Italy, emergency department (ED) triage is a complex and delicate interface in which different emergency healthcare providers interact: physicians, nurses, and pre-hospital rescuers. There are significant differences in the communication, training, and abilities of these providers. Communication failures during the pre-hospital/hospital interface have been identified as a major preventable cause of patient harm. We previously evaluated handover in simulated scenarios, and developed specialized handover training for pre-hospital emergency rescuers. The purpose of this study is to evaluate communication during the clinical handover between pre-hospital to ED staff, using realistic scenarios. A nurse, trained through high-fidelity simulation handover scenarios, used our adapted ISBAR tool to evaluate inter-professional communication at triage. We evaluated and statistically analyzed 240 handovers performed by pre-hospital rescuers over nine observing shifts. On the whole, the data analysis highlights a lack of communication standards, a lack of formal transfer of responsibility of patient care, and a marked inconsistency in information communicated by every professional group examined. Only those rescuers who were previously trained in handover performed 100% of the ISBAR tool items. The information most often communicated was the reason for the call, (85%) and the information least often communicated was the complete ABCDE patient survey (1%). Currently, ED personnel receive poor verbal information from pre-hospital providers. The general habit of pre-hospital providers is to give different written reports to the triage nurses without a true shared transfer of responsibility. This lack of standardization in communication presumably has an adverse impact upon patient care.
authors.affiliation: Inter-institutional Integrated Department, University of Florence and Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy, francescodojmi@yahoo.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dojmi Di Delupis
authors.forename: Niccolò
authors.initials: N
authors.lastname: Mancini
authors.forename: Tommasina
authors.initials: T
authors.lastname: di Nota
authors.forename: Paolo
authors.initials: P
authors.lastname: Pisanelli
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007558:Italy; D062209:Patient Handoff; D014164:Transfer Agreement; D014218:Triage / Q000379:methods*