title: A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study.
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.
authors.affiliation: Research department acute care, HAN University of Applied Sciences, Nijmegen, the Netherlands. Remco.Ebben@han.nl.
authors.forename: Remco H A
authors.initials: RH
authors.lastname: Ebben
authors.affiliation: Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands. Pierre.van.Grunsven@vrgz.nl.
authors.forename: Pierre M
authors.initials: PM
authors.lastname: van Grunsven
authors.affiliation: Emergency Department, Radboud university medical center, Nijmegen, the Netherlands. MarieLouise.Moors@radboudumc.nl.
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Moors
authors.affiliation: Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands. Peter.Aldenhoven@vrgz.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Aldenhoven
authors.affiliation: Emergency Department, Radboud university medical center, Nijmegen, the Netherlands. Jordan.deVaan@radboudumc.nl.
authors.forename: Jordan
authors.initials: J
authors.lastname: de Vaan
authors.affiliation: Ambulance Service Gelderland Zuid, Veiligheidsregio Gelderland Zuid, Nijmegen, the Netherlands. Roger.van.Hout@vrgz.nl.
authors.forename: Roger
authors.initials: R
authors.lastname: van Hout
authors.affiliation: Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium. Theo.vanAchterberg@med.kuleuven.be.|Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, the Netherlands. Theo.vanAchterberg@med.kuleuven.be.
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.affiliation: Research department acute care, HAN University of Applied Sciences, Nijmegen, the Netherlands. Lilian.Vloet@han.nl.|Canisius Wilhelmina Hospital, Nijmegen, the Netherlands. Lilian.Vloet@han.nl.
authors.forename: Lilian C M
authors.initials: LC
authors.lastname: Vloet
mesh_terms: D000488:Allied Health Personnel / Q000193:education*; D000552:Ambulances; D003194:Computer-Assisted Instruction; D003266:Continuity of Patient Care / Q000592:standards*; D004631:Emergency Medical Service Communication Systems; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D009426:Netherlands; D011446:Prospective Studies; D058996:Quality Improvement