How to Handle the Handoff: Working with EMS to Ensure Good Transitions of Care

Why is the EMS Handoff Important?

The absence of good mechanisms for transitioning patient care from the prehospital team—whether it be a ground-based ambulance or paramedic unit or aeromedical unit like a helicopter or fixed-wing—can be detrimental to patient care. In contrast to handoffs between inpatient teams, where the process is generally well defined, transitions from emergency medical services (EMS) providers to hospital teams are often ambiguous.

Emergency medical technicians, paramedics, nurses, nurse practitioners, physician assistants, and physicians all may play a role in caring for a patient from point of injury or illness to arrival in the emergency department, trauma bay, or intensive care unit. Therefore, it is important to have a good handoff to avoid loss of valuable information that could lead to misdiagnosis, delays, or inefficiencies in patient management.

At a minimum, a good handoff from EMS should include the following:

• Chief complaint or mechanism of injury with associated signs and symptoms.
• Description of the scene or environmental factors that could have contributed to illness or injury, including details of extrication or rescue, as appropriate.
• Vital signs (first set on arrival and repeat/trended if change in status).
• Summary of patient care interventions and responses.
• Identification of any critical interventions not yet performed or achieved that should be addressed by accepting team on arrival.
• Opportunity to answer questions and provide clarification as requested by accepting team.

It is difficult to go back and obtain or clarify information that is not shared at the time EMS delivers a patient. Therefore, it is essential that all receiving team members take time to listen to the handoff. This should ideally occur once at the bedside and involve key members of the team accepting the patient, including the treating physician.

Physicians, like other members of the care team, are often busy with multiple patients and clinical tasks, but should prioritize getting to the bedside for the handoff of critically ill or injured patients to get this information firsthand and ask any clarifying questions.

Research has shown that EMS clinicians can become frustrated when there is a lack of an effective handoff process when they arrive at the emergency department or destination facility. For example, a 2014 study by Meisel, et al. found that EMS providers desired to “(1) communicate directly with the ED provider responsible for the patient’s care; (2) increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers; (3) standardize some (but not all) aspects of the handoff; and (4) harness technology to close gaps in information exchange.”