Whether in an emergency or non-emergency situation, the transfer of a patient from their current event to a hospital emergency room, out-patient physician service, or nursing home is the daily occurrence of an Emergency Medical Service professional. The key to a successful transfer and patient’s well-being is not only the physical transfer itself but also includes the well-rounded transfer of said patient’s history and current information; this information includes everything from vital statistics to simple patient whereabouts and logistics.
In the profession, it’s called the “hand-off” or the transfer of patient care from pre-hospital providers such as EMTs, paramedics, and non-emergency medical transfer service providers to emergency department physicians, trauma surgeons, critical care physicians, or non-emergency care facilities.
The complete and comprehensive transfer of a patient’s information represents one of the most important elements of successful care for patients with serious injuries, illnesses, and chronic conditions. One does not think of this too often, but in all “hand-off” situations, patient transfer also involves the transfer of rights, duties and obligations of that patient from one person or team to another.
In his recently published CNBC article, Many Doctors Can’t Manage Multiple Chronic Conditions, author Dan Mangan cited particular information from a survey published in the journal “Health Affairs”, which apparently found that a very low percentage of primary care doctors, only 16 percent, believe the U.S. health system is working well, including the area of patient transfer communications.
Mangan goes on to point out specifically how, “Many of [them] said they aren’t notified when one of their patients leaves the hospital, or is admitted to an emergency department, which can lead to a gap in getting people follow-up care, a particularly serious concern for patients with multiple chronic conditions.”
Based on the survey, Mangan further writes,
These specific findings help give insight to the vital importance of safe patient emergency and non-emergency transfer physically, yet just as importantly, the physical transfer needs to be coupled with comprehensive patient information.
In the online article, Mangan quotes Dr. David Blumenthal, President of the Commonwealth Fund as saying, “Primary care is the hub of patients’ health-care experiences. If it isn’t strong and working efficiently, patients won’t get the best possible care,” (Many Doctors Can’t Manage Multiple Chronic Conditions, http://www.cnbc.com/2015/12/07/many-doctors-cant-manage-multiple-chronic-conditions.html, Dan Mangan, December 7, 2015)
Even though many articles have been written from a “Physician’s/Nurse’s Needs” point of view, one must remember to include the EMS professional in that list of needs so ALL professionals involved in a patient’s transfer, care, and overall well-being have the tools she/he needs to do their job. While this all sounds fairly logical and simple, when the medical event involves the care of a human being, the stress of the situation may cause communication breakdown at any moment or level. So although much thought and literature with regard to medical situation communication has been devoted to physician-to-patient and physician-to-physician communication, the principles gained from these thought processes must include the EMS professional to have a comprehensive positive outcome on every health care level.
The Journal of Emergency Medical Services is a fantastic resource for examining EMS/Physician/Patient relations and communications. Writer Samuel M. Galvagno reminds us, for a medical service provider, nurse, or doctor in the majority of settings, stress levels and communication loads can be extremely high, complex and cognitively taxing. It seems to be fact how interruptions and multiple concurrent tasks may lead to clinical errors due to “disrupted memory processes”. Apparently many studies have shown how, when patient information is conveyed only via verbal means, few facts are retained between medical professional parties involved.
In his JEMS writings, Galvagno shows the reader how miscommunication is common and can disrupt memory and lead to mistakes; hence, “it’s not surprising that medical staff members remember less than half of the information EMS crews give them at verbal hand-offs.” (Effective Communication Between Providers & Physicians Improves Patient Hand-offs, http://www.jems.com/articles/2012/04/effective-communication-between-provider.html, Samuel M. Galvagno Jr., April 12, 2012)
Again, the Journal of Emergency Medical Services is a great resource for everyone in the professional field of patient critical and chronic care. The JEMS website (http://www.jems.com), and Galvagno’s article include tips for communication improvement across all medical care platforms.
The aim of all EMS transfers or “hand-offs” is to ensure a smooth and efficient transfer of the patient(s) from the scene or event to definitive medical care. Much like in the military, training and use of disciplined and structured communication tools can decrease the risk of communication failures, hence improving the health and well-being of the patient and the every-day-life of the EMS professional, EMS Service Provider, Doctor, Nurse, Aid, Home Care-Taker, and all involved in the Health Care profession.
What do you think? Has this list made you think about how serious the lack of communication is in this profession? Leave a comment below to let us know what you think!