Dear Editor,
I write to you with reference to the article: ‘Clinical handover of the trauma and medical patient: a structured approach’ (Loseby et al, 2013).
I was gratified to see this article; I am all too aware of the importance of the clinical handover and to the extent at which it can influence a patient's outcome. Poor communication represents a notable part of complaints in the NHS. This alone underlines this critical skill for the continuity of our patient care.
As a paramedic, I have always deliberated on how I could better my handover. This led me to a secondment on a rapid response car. I felt this would give me an opportunity to develop my handovers with a more concise structure to my fellow colleagues. Doing this for the six months of the secondment gave me ample time and opportunity to build on my handover skills in an everyday environment. I found this beneficial for cognitive skills when in a more time-critical environment.
Each of the mentioned pneumonics (ASHICE, SBAR, AT MIST, HEMS templates) can be articulated by the individual clinician, handing over with thought out clinical reasoning and decision making. However, the clinician needs to maintain the receiving handover staff members' attention in a busy, noisy department.
The acutely ill patient can change critically in the first 3-4 hours. Potentially, ambulance trusts could consider discussing with individual A&E departments the use of an Early Warning Score in a pre-alert, which may assist a receiving facility with continuity. Each hospital's emergency department (ED) potentially uses a different system. There are over 300 such scoring systems available. However, local ambulance staff working in local EDs could potentially assist the multi-disciplinary approach by communicating in the same ‘language’. This in turn could lessen the break down in communication and improve the continuity in our patients' care at a local level.
The structured approach that is defined to us when dealing with major trauma (i.e. TEMPO Guidelines introduced by NHS East of England Trauma Network) clearly simplifies a complex environment, enabling clinicians involved to maximise on communications. This encourages multi-disciplinary cooperation, which will promote structured and efficient handover communications for us to elaborate and facilitate best practice on in the future.
I thank you for the thought-provoking article.