66 - Identification of Barriers to a Standardized Patient Handoff Process Between Prehospital and Pediatric Emergency Department Providers

Poster Number: 66
Publication Number: 66.408

Vishal Naik, Northwestern University / Lurie Children's Hospital, Chicago, IL, United States; Erica Popovsky, Lurie Children's Hospital, Chicago, IL, United States; Karen Mangold, Ann & Robert H. Lurie Children's Hospital/Feinberg School of Medicine/Northwestern, Chicago, IL, United States; Jacqueline B. Corboy, Ann & Robert H. Lurie Children's Hospital of Chica, Wilmette, IL, United States; Mark D. Adler, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: Information provided during handoff of ill children between emergency medical service (EMS) and pediatric emergency department (PED) providers can be incomplete or inefficient, leading to delays in care and negative patient outcomes. Currently, no pediatric-specific method exists to guide EMS or ED staff during this critical time period and little is known about the existing emergency department barriers to this process.

Objective:
Identify barriers to rapid and complete handoff of critical information from EMS to PED providers
Develop a quality improvement (QI) initiative to create a standardized EMS transfer of care process by March 2022 via modified Delphi

Design/Methods: In preparation for a larger interventional quality improvement project to improve transfer of care between EMS and PED providers, a collaboration was developed between our Level I pediatric trauma center, its critical care transport team, and our large, local, urban fire department. Given the lack of literature on the topic, we decided to perform a barrier assessment to better characterize the factors that hindered rapid and complete handoff of information between EMS and PED providers. Between the months of March and August 2021, a written survey inquiring about perceived barriers in transfer of care was given to PED nursing and physician staff and EMS providers. The surveys were analyzed and information was used to create a fishbone diagram. The diagram was then presented at an institutional conference of trauma nursing and physician staff to obtain further input. This barrier assessment will be used to develop key drivers, process and balancing measures, and inform the project’s national modified Delphi to create an EMS to PED handoff tool.

Results: A total of 43 surveys were completed by nursing, paramedic, and physician staff in the Emergency Department (51% nursing, 11% paramedic, 38% physician). This information was then formulated into a fishbone diagram (Figure 1). There were no additions made to the diagram following its presentation to a virtual conference of Trauma nursing and physician staff. Conclusion(s): This project is the first of many steps to standardize the handoff of pediatric patients during a vital and error-prone period in their care. To our knowledge, this is amongst the first attempts to evaluate specific barriers to rapid and complete handoff of critical information from EMS to PED providers. Future attention will turn towards the development of interventions such as the creation of a transfer of care process via a national modified Delphi.
Figure 1. Transfer of Care Fishbone Diagram