Requirements for a Smooth Handoff

Background  Hand-offs are a high risk area and prone to errors, which can lead to adverse effects to the patient’s we serve.  A comprehensive report is needed as soon as possible.  EMS to ED hand-offs should mirror how hand-offs are performed at definitive care facilities (verbal report followed by a comprehensive written report).

Background Continued  A verbal report at the time of transfer is extremely important and must contain critical information. Absent information can lead to poor patient care in the emergency department.  A comprehensive written report must be completed as soon as possible and be readily available to emergency department staff to facilitate quality of care.  The above points must be balanced with the need for available resources in the community to respond to other emergency incidents.

The Hand-Off (Verbal Report)  Date and time of the emergency  Name of patient  Age of patient  All current medications and allergies  Time of onset of symptoms  Patient vital signs (including serial vital signs)  Patient assessment findings  Procedures and therapies provided by EMS  Any changes in patient condition while in the care of EMS  Mechanism of injury or type of illness  Hard copy of ECG/rhythm strip  Unit identifier (i.e. M5, A72)

Hand Off (Fine Print)  Your reports are read by Emergency Department staff.  The transporting agency shall complete and deliver to the Emergency Department the ENTIRE* report within 60 minutes from transferring care.  All critical ALS calls must be completed at the facility prior to departure (think ALS2 type calls).  Transporting agencies finishing reports at hospitals within their response zone may respond to another emergency incident provided a verbal report has been given to the receiving physician.  Any unfinished report(s) shall be finished immediately after the second incident  Agencies using ESO (electronic PCR) may leave the emergency department as long as the report is completed (locked) and the report is synched within the 60 minute time frame.

Hand Off (Fine Print) Continued  EMT’s and Paramedics, at any time and as directed by the receiving physician, may be required to complete the medical incident report before leaving the emergency department.  *ENTIRE with regard to the electronic patient care report means a locked report. A draft report is not considered complete. For those completing a paper based medical incident report, all clinical information must be complete, all demographic information must be complete, and all medications, allergies, and history, must be complete prior to departing the emergency department.  The responsibility to police the completion of reports within 60 minutes of delivery rests on the MSA/MSO’s of EMS agencies.

History  This revision was developed with input from: WAC , Medical Control Committee, Various Fire Chiefs, and Hospital Emergency Departments.  This protocol revision represents the best interests of all of the above mentioned parties.  There have been cases where bad outcomes have resulted from poor hand-offs between EMS and Hospital staff.  The goal of this protocol revision is to ensure that there is solid communication, and excellent documentation in order to provide first-rate care to the patient’s that we serve, so that they obtain the treatment that they deserve; at the same time maintaining adequate resources in the field to meet call volume.