Clinical handover from Paramedic Services to the trauma team: a video review analysis of the IMIST-AMBO protocol implementation

Clinical handover from Paramedic Services to the trauma team: a video review analysis of the IMIST-AMBO protocol implementation

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    Marie Pinard 22 June 2021

    The video really enhanced exploration of this great QI work - thanks so much for including it! The data collection is very comprehensive and answers just about every question I could possibly have about how the intervention was implemented. Do you think that the use of video was a key success factor for your data capture? Any insight as to why certain protocol elements have lower adherence? Are there plans to measure for sustainability in the future?

  • 23 June 2021

    Very interesting and challenging project that's showing impact on processes of care. It would be great to have some of the primary outcomes in the run chart. Well done!

  • Cara Elliott 23 June 2021

    Hi Marie. Thank you for your comments and interest in our project. Re the video: We have not looked at the performance of those who watched the video vs. those who did not, but this brings up a very interesting question. Just based on what I've personally noticed, the tool is so user-friendly that even those who had no familiarity with it prior to entering the trauma bay could use it during their handover without training, as long as they had the tool written out in front of them. (Note, our trauma bay has a large poster with the protocol on it, right beside the patient bed). Re lower adherence: This is a great question. I think some of categories were adhered to less often because of the comprehensive, streamlined nature of the tool in its entirety. More specifically, some of the lowest adherence categories were the second 'Pause for questions' and the 'Other' category. For the second 'Pause for questions', perhaps because the most critical information was already communicated, the TTL had less use for this category to clarify something with the paramedic. For the 'Other' section, we believe that by the time the paramedic got to the end of the handover, they had already communicated the most critical information and had less 'extra info' to put in the 'Other' category. Finally, regarding Airway, often the patient had an obviously in tact airway during their handover (i.e. GCS 15, talking and patent), so perhaps the paramedics did not feel it necessary to communicate this category. Re future directions: We currently have ongoing discussions with St. Michael's Hospital, Scarborough General Hospital, and Hamilton Health Sciences Centre about implementing this tool, including the transferability of this tool into the different clinically settings (i.e. the Emergency Department) as well. Fortunately, there is lots of opportunities for further study on the horizon!

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    Marie Pinard 24 June 2021

    Cara, thank you so much for these additional insights. There is always so much more learning from a QI project that can be gained from the poster alone. Some of your predictions/assumptions make a lot of sense. Your point about a GCS15 talking patient is striking and makes me wonder if it's bit awkward to do a comprehensive handover with the patient there. Not something I would have thought of in relation to trauma patients. Thank you so much for responding. It's been fun to engage on the platform this way. I hope you are able to spread this project and continue the learning. Congratulations again to the team.

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