title: Lost information during the handover of critically injured trauma patients: a mixed-methods study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida, USA.
authors.forename: Tanya Liv
authors.initials: TL
authors.lastname: Zakrison
authors.affiliation: Faculty of Medicine, Institute of Medical Sciences, Toronto, Ontario, Canada.
authors.forename: Brittany
authors.initials: B
authors.lastname: Rosenbloom
authors.affiliation: Departments of Surgery and Laboratory Medicine, Trauma Program and Transfusion Medicine, Toronto, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: McFarlan
authors.affiliation: Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jovicic
authors.affiliation: Department of Psychiatry, Center for Addictions and Mental Health, Toronto, Ontario, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Soklaridis
authors.affiliation: Department of Surgery, Trauma & Surgical Critical Care, Miami, Florida, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Allen
authors.affiliation: Department of Surgery, Trauma & Surgical Critical Care, Miami, Florida, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Schulman
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Departments of Surgery and Laboratory Medicine, Trauma Program and Transfusion Medicine, Toronto, Ontario, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D008505:Medical Staff, Hospital / Q000458:organization & administration; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D017064:Process Assessment, Health Care; D013315:Stress, Psychological / Q000453:epidemiology; D013997:Time Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Checklists; Critical care; Emergency department; Hand-off; Team training