Communication is the exchange of information between a sender and receiver. Understanding communication is vital to EMS and other healthcare providers. Effective communication should be complete, precise, brief, timely and prioritized in order of importance. A large portion of an EMS student’s education comes from a variety of textbooks, but another portion comes from personal experience that they’ve gathered while responding to calls, attending conferences or completing training sessions.
EMS can learn an important lesson from its colleagues in the nursing profession. The patient “hand-off” is an area that nurses have perfected, principally because it happens so frequently during a patient’s hospital stay. A patient hand-off occurs during each transitional phase of a patient’s stay in the hospital (e.g., emergency department to ICU, ICU to operating room) “¦ the list goes on. This article will focus on several important areas of patient hand-off and help instructors convey this important information to their students.
The Theory
We have to first understand where the patient hand-off starts. It starts when EMS first makes contact with the patient. A patient hand-off is often thought of as a formal interaction between health professionals, but a hand-off occurs once you initially access a patient.
Obtaining the necessary information during patient interaction is paramount to a successful patient hand-off later. Patient hand-offs also take place from first responders to EMS, and within EMS from BLS to ALS or ALS to a flight crew.
Having your students understand why this is important is critical to making them successful EMS providers. Providing adequate instruction in a patient hand-off is invaluable and should be an ongoing process that isn’t highlighted during just the initial training.
Although regional or state protocol may dictate the use a specific approach, procedure or form, it’s important to understand that the primary reason for standardizing patient hand-offs is to ultimately improve communication and decrease time-to-care at the hospital. It’s therefore important for instructors to present this topic in a way that caters to students with varied learning styles.
Nursing uses the mnemonic SBAR (situation, background, assessment, recap/Rx) to help them work through patient hand-offs. There’s also another mnemonic that’s been developed as a tool specifically designed to aid EMS with performing concise and precise hand-offs for trauma patients: MIVT (mechanism, injuries, vitals, treatment). Mnemonics are easy to remember, making them an effective tool for EMS.
Additionally, there’s currently a national healthcare initiative to decrease patient errors.1,2 Research strongly suggests that incorporating standardization into patient care, as well as patient hand-offs, greatly diminishes the potential for error. Errors can occur when information isn’t transitioned from one healthcare provider to another. Nursing has championed a national effort to decrease, and hopefully eliminate, patient errors, and it should drive EMS to do the same.
The Practice
So let’s take a look at the mnemonic SBAT.
Situation/Scene: Teach EMS personnel to start their report to the hospital with the unit designation, crew member name and certification level, quickly followed by a brief, concise–yet thorough–presentation or description of the scene or incident. Then, give the patient’s gender, age and chief complaint.
Background: This is the history of present illness (HPI) or information on the background of what happened to the patient. Provide more in-depth, precise information. Also include pertinent medical history, medications and allergies (specifically if a medication should be given). Convey only relevant information.
Assessment: Provide pertinent assessment findings, including a general impression of the patient. Include stable versus unstable observations, as well ECG findings, blood glucose levels and a stroke scale if it relates to the patient. You’ll also want to include baseline vital signs and pain level rating, if applicable for the patient.
Treatment: Explain what treatment was given. Include the patient’s response to treatments rendered. Also indicate whether the treatments rendered were effective. This is the time to restate concerns about the patient and to respond to questions.
The second mnemonic, MIVT, is specific to trauma patients but follows the same mantra of SBAT.
Mechanism: Describe the mechanism of injury related to the traumatic event or injury, and ensure your students know to include injury specifics about height of fall, speed of vehicle and other blunt or penetrating mechanisms.
Injuries: Indicate obvious and suspected injuries. Also, include a patient’s complaint in this section.
Vitals: Give a thorough and complete set of vital signs, including Glasgow Coma Scale score, pupillary response and any significant changes in the vitals throughout the patient contact time.
Treatment: Explain treatments rendered and the response to the treatment. Also include any significant changes to the patient’s condition.
You should teach these mnemonics with another foundation–that the patient hand-off should occur in 45 seconds or less. There’s no reason for lengthy and long-winded reports because they delay patient care.
Your students will likely ask you when to use a formalized in-person patient hand off.
As is standard practice in EMS education, the answer is, “when it’s appropriate.” So when is appropriate? Every time a patient is transferred from one entity to another, or from one provider to the next. However, there’s a time that a formalized hand-off shouldn’t be used: when a life-threatening situation requires immediate attention.
Next, consider the varying age of your learners. Adult learners are motivated by self-esteem and achievement, rather than rewards. So instructors need to maintain an atmosphere that promotes learning, involving the students in the learning process through question-and-answer sessions. Adult learners should be in a flexible learning environment.
You can easily present this material in a traditional classroom setting, ensuring you’re aware of your audience. If you’re teaching this to new providers in their initial training, you’ll need to cater your presentation style and methods to incorporate more background, explaining why this process is necessary.
With experienced providers, you can take a more detailed and concise approach. Using traditional handouts or PowerPoint presentations is an effective approach for explaining SBAT and MIVT. You can also use a reference card or a fill-in-the blank sheet that would follow the mnemonic, so the student has something for future reference.
Conclusion
Patient hand-offs occur every time patient contact is made, and we must remember that effective communication is paramount to making a safe and successful transition. We must ensure our audience understands all aspects of how to be effective communicators, as well as active listeners who understand what’s being communicated. Good communication skills reduce misunderstandings, errors, frustration and conflict on a daily basis.
Implementing a simple tool to remember the necessary items that need to be conveyed during a patient hand-off will not only make it easier, concise and timely, but it will also prevent errors and omissions. The mnemonics SBAT and MIVT will give students the ability to remember what to say and when to say it during a hand off and streamline interactions between EMS and hospital staff. JEMS
References
1. Kaiser Permanente of Colorado. n.d. SBAR Technique for Communication: A situational briefing model. Institute for Healthcare Improvement. www.ihi.org/IHI/topics/patientsafety/safetygeneral/toolsSBARTechniqueforCommunicationASituationalBriefingModel.htm.
2. Safer Healthcare. n.d. SBAR: A communication technique for today’s healthcare professional. Safer Healthercare. www.saferhealthcare.com/cat-shc/sbar-a-communication-technique.
This article originally appeared in July 2011 JEMS as “The Hand Off: Smooth transitions between healthcare providers.”
