Does the EMS-ED Patient Transfer Process Need a Hand?

Patient transfers continue to present challenges and risks for hospitals.
In fact, according to the Joint Commission Center for Transforming Healthcare, “An estimated 80 percent of serious medical errors involve a lack of communication between caregivers when patients are transferred or released.” For patients taken to the hospital by ambulance, care actually begins with the “first medical contact” from Emergency Medical Services, which adds additional layers to the transfer issue. From the moment the 911 call is made until the patient is treated by a doctor or a team of specialists (such as urgent life-saving acute care such as STEMI, stroke, trauma, or sepsis), the information has changed hands up to Eight times. Each transfer generates a very large (and very worrying) margin of error. Do you remember playing “Telephone” when you were a kid? One person whispered a statement to another, who passed it on to the next … when the fourth person received it, it was very different from the original message. Well, in a life or death situation, there is nothing funny about inaccurate or missing information.

Let’s examine the chain of information related to care.
A call is made to 911; a brief history of the emergency and the patient’s situation is given to the dispatcher, who passes that information on to the responding emergency ambulance. First aid paramedics and emergency medical technicians arrive on the scene, assess the patient, obtain a history, and initiate care. They collect additional data and vital signs, select the destination hospital, and prepare for transport. At some point, EMS consults with a hospital nurse or doctor for medical instructions or simply calls or radioed a summary as a notification to the receiving emergency department. This patient report is (hopefully) relayed to other members of the ER staff prior to the arrival of the ambulance. That is transfer number three and the patient has not yet arrived. Upon arrival, the patient is handed over to the waiting nursing staff, who compiles a summary of EMS care before leaving. As emergency service providers take over patient care, nurses pass on all of this data to arriving physicians, usually reiterated verbally or through notes, from which treatment is derived. For acute care cases, there are still urgent additional transfers to CT-Scan or Cath-Lab, and to cardiology, neurology, and trauma specialists.

Was it a bit difficult to follow all that?
It seems easy enough for details to get lost in translation, right? This is not a new topic, which is why the transfer of patients between EMS and the ED is called “a critical moment in patient care” in a recent NAEMSP blog. With today’s emphasis on patient outcomes and reducing costs and risks, the use of mobile telemedicine, HIPAA secure notifications, and digital forms are viable and cost-effective tools to dramatically reduce that error rate. Which brings us back to the question. Does your EMS-ED transfer process need a hand?