Handover from prehospital to hospital teams is a key part of the patient’s trauma journey. It is vital that this is a controlled process. It’s also done in lots of different ways, and perhaps there is no perfect way, but there are strategies that seem to help, and strategies that seem to consistently make it worse. I’ve been involved in hundreds, if not thousands of handovers over the years, both from the EM and PHEM perspectives and I’ve seen it work well, and really, really, really badly! These are my TTL tips to make a non-urgent handover work well.
Obviously, if your patient is actively dying or if there are more complex elements, then you may have to do things differently, and we will cover those more complex handovers in future posts.
- Brief the trauma team in advance as to how you want handover to take place. So before the patient arrives tell everyone in the room how the handover will work, clear space, emphasise that it’s an opportunity for everyone to learn about the patient. I often remind people that an extra 30 seconds of sharing information now will save LOTS of time later.
- Here we are focusing on the initial handover, but do ensure you address all the other ZPS elements that are needed in any trauma patient.
- Organise the room so the team can access and have all the kit ready to move the patient (where’s the PATSLIDE you ask? – also did you know that the PATSLIDE was invented by a chap called Patrick (PAT’s slide) in a Virchester hospital*, colleagues were so impressed with the idea they named the device after him, more details below.
- When the prehospital team arrives ask them if there ‘Are any immediately life threatening injuries?’ (and if so act upon them, and flip to a rapid handover approach). Consider a quick pulse and a AVPU check. We will address the actively dying patient in future TTL tips, but let’s face it those patients are pretty rare.
- If no immediate life threats ensure a sterile handover and that everyone listens. We suggest that in most circumstances you should do the following.
- Handover before moving the patient onto the ED trolley (this avoids distractions). When the patient arrives the team is often primed to do things, to get things moving and to make things happen. As soon as someone puts hands on the patient, control can be lost as people move lines/straps/meds/blankets/trolleys/cannulate etc. If you want people to listen, then do that as an active listening exercise. Bottom line is that you and your team cannot multitask here. Listen, OR do. Don’t try and do both, because you cannot and neither can your team.
- If you do choose to move and then handover you will need to reset the team to get them to pay attention to the pre-hospital team. This is hard, which is why I generally don’t do it.
- Support the prehospital team using an ATMIST handover. I often ask if the prehsopital team are happy to give an ATMIST, if they are then great! If the team looks blank or nervous then you can guide them through this. Write it down (or if you’re lucky enough get your scribe to do this).
- Make the handover sterile. EVERYONE should listen whilst the prehospital team talks. Stop people fiddling with trollies, monitors, leads, etc. so that the whole team gets the whole handover. Remember that an extra 1-2 mins getting a good handover is a tiny amount of time in the patients journey and it will likely give you critically important information.
- Watch what happens once people start fiddling with stuff, you’ll see half the room stop listening/looking at the handover and start watching activity. Happens every time (if you let it).
- Ensure that the prehospital information is transferred onto the hospital record. This will vary depending on which system you use, but it alwayus holds vital information so make sure it happens.
- Handover before moving the patient onto the ED trolley (this avoids distractions). When the patient arrives the team is often primed to do things, to get things moving and to make things happen. As soon as someone puts hands on the patient, control can be lost as people move lines/straps/meds/blankets/trolleys/cannulate etc. If you want people to listen, then do that as an active listening exercise. Bottom line is that you and your team cannot multitask here. Listen, OR do. Don’t try and do both, because you cannot and neither can your team.
- BE NICE to the prehospital team. They’ve probably just had a really tough time getting the patient to you with less people, light, warmth and information. Don’t be ‘that’ TTL that all the paramedics and PHEM clinicians talk about…….
vb
S
Note: When I’m training TTLs I often recommend that they actively try different techniques (e.g move before/after handover), and do this as a purposeful experiment with reflection. Pretty much everyone settles on handover before move.
The other hat: When I am working as a HEMS team, on the other side of the fence, I ask the TTL what they would prefer. ‘The patient is stable and there are no immediate concerns, would you like handover now, or after we have moved them across to your trolley.’
PATSLIDE * This is clearly untrue but was once told to me by a real fibber, so I’m keeping the tradition going.
