EMS A to Z: The Patient Handoff

Show Notes:

From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn

A 2014 position statement from ACEP, NAEMSP, NAEMT, NASEMSO states that: 

“Clearly defined processes for the contemporaneous face-to-face communication of key information from emergency medical services (EMS) providers to health care providers in an emergency department (ED) are critical to improving patient safety, reducing medicolegal risk, and integrating EMS with the health care system.” 

The MIST format is one of the most commonly used, standardized, formats for patient handoff:

Developed by The Southwest Texas Regional Advisory Council (STRAC))

M: Mechanism of illness / injury

I: Injuries or inspection

S: Vital signs & glucose 

T: Treatment 

What is a good structure for the handoff? 

Nurse calls "EMS Time Out"

Patient movement and conversations stop

EMS delivers patient report

Receiving nurse completes form

Nurse provides EMS patient sticker

Patient moved to hospital bed

The Central Ohio Trauma System rolled this out over 2 years with training of the EMS agencies, receiving facilities – initially looking at handoffs pre-implementation, and then post implementation: 

In Phase II, 46% of the hand-offs were recorded at less than 60 seconds versus 21% in Phase I

All vital signs were reported in 80% of Phase II compared to only 20% of Phase I

Demographics were captured at rate of 92% in Phase II versus 69% in Phase I

In Phase I, the longest hand-off was 15 minutes and in Phase II, it was 6 minutes.