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Design and trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO’
  1. Rick Iedema1,
  2. Chris Ball1,2,
  3. Barbara Daly3,
  4. Jacinta Young4,
  5. Tim Green5,
  6. Paul M Middleton6,
  7. Catherine Foster-Curry7,
  8. Marea Jones6,
  9. Sarah Hoy8,
  10. Daniel Comerford8
  1. 1University of Technology Sydney, Centre for Health Communication, Sydney, New South Wales, Australia
  2. 2HSPIB, NSW Ministry of Health, North Sydney, New South Wales, Australia
  3. 3Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
  4. 4Ambulance Service NSW, Bellingen Ambulance Service, Urunga, New South Wales, Australia
  5. 5Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  6. 6Ambulance Research Institute, Ambulance Service of NSW, Sydney, New South Wales, Australia
  7. 7Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
  8. 8NSW Health, Health Services Performance Improvement Branch, Sydney, New South Wales, Australia
  1. Correspondence to Professor Rick Iedema, University of Technology Sydney, Centre for Health Communication, PO Box 123, Broadway NSW 2007, Sydney, NSW 2007, Australia; r.iedema{at}


Background Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients' subsequent hospital treatment and trajectory of care.

Aim The study's aims were to: (1) identify the existing structure of paramedic-to-emergency staff handovers by video recording and analysing them; (2) involve practitioners in reflecting on practice using the footage; (3) combine those reflections with formal analyses of these filmed handovers to design a handover protocol; (4) trial-run the protocol; and (5) assess the protocol's enactment.

Method The study was a ‘video-reflexive ethnography’ involving: structured analysis of videoed handovers (informed by ED clinicians' and ambulance paramedics' comments); ED clinicians and ambulance paramedics viewing their own practices; and rapid at-work training and feedback for paramedics. A five-question pre- and post-survey measured ED triage nurses' perceptions of the new protocol's impact. In total, 137 pre- and post-handovers were filmed involving 291 staff, and 368 staff were educated in the use of the new protocol.

Results There was agreement that Identification of the patient, Mechanism/medical complaint, Injuries/information relative to the complaint, Signs, vitals and GCS, Treatment and trends/response to treatment, Allergies, Medications, Background history and Other (social) information (IMIST-AMBO) was the preferred protocol for non-trauma and trauma handovers. Uptake of IMIST-AMBO showed improvements: a greater volume of information per handover that was more consistently ordered; fewer questions from ED staff; a reduction in handover duration; and fewer repetitions by both paramedics and ED clinicians that may suggest improved recipient comprehension and retention.

Conclusion IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the resulting protocol, strengthened ED clinicians' and ambulance paramedics' sense of ownership over the protocol and bolstered their peers' willingness to adopt it.

  • Handover
  • ambulance
  • emergency department
  • protocol
  • communication
  • health policy
  • never-events
  • near-miss
  • safety culture
  • shared decision making
  • quality improvement
  • process mapping
  • patient safety
  • prehospital care
  • evidence-based medicine
  • evaluation methodology
  • critical care
  • management

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  • Funding The work was supported by funding from the New South Wales Ministry of Health on behalf of the Ministerial Task Force for Emergency Care.

  • Competing interests None.

  • Ethics approval Ethics approval was given by the Hunter New England Human Research Ethics Committee of Hunter New England Health, and site-specific ethics approval from Sydney South West Area Health Service, and Hunter New England Area Health Service.

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