Information Transfer for Multi-

trauma Patients on Discharge

from the Emergency

Department DR PAULINE CALLEJA, PROF LEANNE AITKEN, PROF MARIE COOKE

CENTRAL WEST HOSPITAL AND HEALTH DISTRICT, PRINCESS ALEXANDRA HOSPITAL, GRIFFITH UNIVERSITY

Outline Background

Research method

Study context

Outcomes:

How to improve information flow at handover to improve patient outcomes

Development of a minimum dataset and

documentation requirements

Identification of barriers and conduits to information transfer for patients at vulnerable transition points

Background Why this? What’s the problem?

What the literature says:

Transition points are most vulnerable, at change of

practitioner/shift but more so at change of

department/transfer inter-hospital or ward

Information loss at transfer affects patient outcomes,

errors such as missed injuries, incorrect or repeated

treatments and disrupts continuity of care

Communication cornerstone of care, but complex

Complexity increased with number of people involved

Research method Multi-phased, mixed method, concurrent

intervention study

Phase 1

Context appraisal

Literature review

Focus groups

Staff survey

National and international

practices

Patient chart audit

Phase 2

Strategy development

Strategy development

working group

Rationalisation and approval of

proposed strategies

Phase 3

Strategy implementation

Implement strategy devised

in Phase 2’s working group

with use of practice

development framework

Phase 4

Strategy evaluation

Focus groups/ change agent information

Staff survey

Patient chart audit

Study Context

The setting for this study was one major metropolitan

ED with a trauma service in Queensland, Australia

The context of the hospital was a tertiary referral centre, undergoing magnet credentialing

Information flow at handover

Variability in practice

Continuity of staff

Being able to put together a picture of the

patient from information provided

All affected by values and context of staff

involved

Improving information flow

Understand the variables involved

Shared understanding of patient be expectation

of handover

Agreed minimum data set

Embed data set, based tools on it

Clinician driven change

MDS & documentation requirements

Needs to be memorable, practical and structured

We modified SBAR to provide the overt structure and

modified the details

Base tools on the dataset required

Dataset may also serve dual purpose for data

collection for patient health outcomes studies

Documentation…specifically

Clinicians in ED - awareness of documentation quality

Documented information most valuable

Information discrepancy

Clarity, relevance and ease of use of forms paramount

Increased patient acuity = decreased documentation

Barriers & conduits

Generally the same things,

Positives and negatives of each other

Depended on:

the clinician’s choice of action,

knowledge

attitude

environment factors

practices they subscribed to

Barriers and conduits

Variability

Expectations

Knowledge and skills

Information handed over

Information documented

Processes used

Continuity

Clinician

Documentation provides full story

Time of day of transfer

Time to document in resus

Processes

Information discrepancy

Putting the

pieces together

Missing pieces

Ease of navigation to information

Surprises at handover

Expectations and actions aligned

Conclusion clear, concise, pertinent, communication

relevant, clear documentation that

accompanies the patient

both sender and receiver involved in

handover

standardised processes

expectations differ based on practice area

Questions or comments?