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Lost information during the handover of critically injured trauma patients: a mixed-methods study
  1. Tanya Liv Zakrison1,
  2. Brittany Rosenbloom2,
  3. Amanda McFarlan3,
  4. Aleksandra Jovicic4,
  5. Sophie Soklaridis5,
  6. Casey Allen6,
  7. Carl Schulman6,
  8. Nicholas Namias1,
  9. Sandro Rizoli3
  1. 1Department of Surgery, University of Miami, Miami, Florida, USA
  2. 2Faculty of Medicine, Institute of Medical Sciences, Toronto, Ontario, Canada
  3. 3Departments of Surgery and Laboratory Medicine, Trauma Program and Transfusion Medicine, Toronto, Ontario, Canada
  4. 4Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
  5. 5Department of Psychiatry, Center for Addictions and Mental Health, Toronto, Ontario, Canada
  6. 6Department of Surgery, Trauma & Surgical Critical Care, Miami, Florida, USA
  1. Correspondence to Dr Tanya Liv Zakrison, Surgery, University of Miami, 1800 NW 10th Ave., Miami, FL 33136, USA; tzakrison{at}med.miami.edu

Abstract

Background 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.

Methods 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.

Results 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.

Conclusion 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.

  • Checklists
  • Critical care
  • Emergency department
  • Hand-off
  • Team training

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Footnotes

  • Twitter Follow Tanya Zakrison at @tzakrison

  • Contributors TLZ, BR, AM, and SR: planning, conducting research and manuscript writing with quantitative data analysis. AJ and SS: qualitative data analysis and interpretation. CA, CS, SR and NN: analysis and interpretation of overall data with critical revisions to manuscript.

  • Funding St Michael’s Hospital Innovation Fund.

  • Competing interests None declared.

  • Ethics approval The institutional review board from St Michael's Hospital approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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