Presentation
An Integration of Perspectives in Improving EMS-ED Care Experiences: Anthropology and Human Factors Approaches
DescriptionRichard Simonson (Moderator), Ph.D., Children’s Mercy Hospital and University of Missouri Kansas City School of Medicine, Human Factors Scientist.
Handoffs between healthcare professionals represent a complex interaction between one or more providers aimed at transferring complicated patient information. For decades, research and quality improvement initiatives have focused on enhancing patient handoffs, resulting in guidance to more effectively standardize and structure the coordination and communication of essential information. Despite the extensive study dedicated to improving handoffs, the effectiveness of the developed interventions continues to be scrutinized by both healthcare practitioners and researchers; patient transfers remain a significant source of medical errors in the healthcare system.
These issues are evident during pre-hospital to ED handoffs, particularly highlighted by the negative interactions and outcomes reported by care teams. While the literature on this topic is currently limited, it suggests that poor handoff practices may contribute to increased rates of moral injury, burnout, feelings of being devalued, and instances of missed or lost patient information during transfers. This discussion panel will include a transdisciplinary group of experts who will aim to synthesize the evidence surrounding these interactions, describe initiatives to enhance the socio-technical interactions during these handoffs, and propose a call for further research to assess the potential link to patient safety.
Erik Prytz, Ph.D., Linköping University, Senior Associate Professor.
It is said that a chain is only as strong as its weakest link. The first link in the Trauma Chain of Survival is first aid provided by immediate responders who happen to be near the accident. This is a vital step in the time between an accident occurs and professional first responders arrive at the scene. Educational initiatives such as the Stop the Bleed campaign aim to support these immediate responders by providing training in specific first aid techniques to stop life-threatening bleedings, such as direct pressure or tourniquet application, and empowering them to act in real emergencies. Other educational initiatives, such as most cardiopulmonary resuscitation classes, are similar. These outreach programs are essential, yet questions remain concerning strengthening this first link in the chain. One approach is to incorporate human factors aspects beyond the technical skills, for example, teamwork or communication skills, to enhance the cooperation between multiple immediate responders and between immediate responders and first responders.
Jakob Hanschu, National Farm Medicine Center, Research Specialist and Socio-Cultural Anthropologist.
Agricultural operations are complex sites that often involve non-standard spatial organization and unique hazards, complicating emergency response efforts. Additionally, contemporary members of rural fire departments and other first responders have, on average, less familiarity with agriculture than their predecessors, due to demographic and economic trends. Thus, agricultural emergencies are low-frequency, high-risk events for first responders. Emergency
events such as car crashes or carbon monoxide calls are common, and thus many emergency departments are familiar with these events and highly proficient at responding to them. Agricultural emergencies, on the other hand, are relatively infrequent, so departments are less practiced at responding to them. To increase agricultural emergency preparedness among rural first responders, the National Farm Medicine Center has developed two programs: 1) Rural Firefighters Delivering Agricultural Safety and Health (RF-DASH) and 2) Agriculture Rescue Training (ART). RF-DASH trains rural first responders in agricultural emergency prevention and preplanning as well as farm hazard assessment. ART utilizes simulated agricultural emergency events to provide first responders with hands-on training in the technical rescue aspects of agricultural emergencies. The origins and various components of these two programs will be discussed, highlighting successes and challenges to program implementation. Further, building on the presentation of the ART and RF-DASH programs, the broader potential for simulation- and scenario-based learning in rural and agricultural emergency preparedness training will be discussed.
Yuval Bitan, Ph.D., Ben-Gurion University of the Negev, Associate Professor.
Effective information handover is a critical component of patient care during the transition from the pre-hospital setting (Emergency Medical Services - EMS) to the hospital Emergency Department (ED). The transition of care from EMS paramedics to ED personnel during healthcare handover is marked by a power disparity between these two groups of healthcare providers. As in many other transitions in healthcare the receiving side is considered to be more advanced and sophisticated. The disparity between EMS and ED personnel leads to gaps in the way EMS information is delivered and processed by the ED.
In this panel I’ll present some of the data we collected in a baseline study at one hospital in Israel, and discuss the importance of future research on this topic. Our findings, based on observations and surveys, mainly point to the difference between synchronous (verbal) and asynchronous (printed) information delivery. Furthermore, the study also highlights the missing opportunity to receive from the EMS team unique information about the patient's environment at the time of the call. This encompasses crucial details about the patient's home or the circumstances of the incident that brought them to the ED.
Yui-Yee Raymond Chan, M.D., Children’s Mercy Hospital and University of Missouri Kansas City School of Medicine, Hospitalist and Human Factors Scientist.
Trauma-based interventional care is often described as prescriptive in nature and necessitates accurate quickly relayed, and structured information to inform optimal care decisions at the right time. The majority of trauma-based handoff interventions have been developed under this structure, with tools that nudge pre-hospital staff to provide structured information that feeds into the standardized nature of trauma-based care assessment. This structure, however, may dissolve as the patient encroaches into the threshold from complicated to complex.
Hilligoss and Moffatt-Bruce (2014) argue that many of the issues currently proposed for pre-hospital to ED strategies lend themselves to a causal, logical approach, which in turn misses complex issues that rely on contextual information. In their discussion on the limitation of checklists, Hilligoss and Moffatt-Bruce draw inspiration from the work of cognitive psychologists Jerome Bruner (1986) and Glouberman and Zimmerman (2002), who describe two
methods of thought: the paradigmatic and narrative. These modes of thinking are mutually exclusive and represent different ways information is explained. Paradigmatic or logico-mathematical employs rule-based explanations, like those present in trauma-based assessments, while the narrative mode focuses on understanding human experiences and intentions. We propose an extension of Hilligoss and Moffatt-Bruce's assessment that many handoff initiatives apply these concepts to handoffs but are primarily limited to the paradigmatic mode of thinking. However, my experiences as a provider show that a single handoff may require the inclusion of narrative experiences to communicate both the complicated and the complex information to inform patient care assessments and decisions best. Understanding when to use these modes may benefit future research.
Handoffs between healthcare professionals represent a complex interaction between one or more providers aimed at transferring complicated patient information. For decades, research and quality improvement initiatives have focused on enhancing patient handoffs, resulting in guidance to more effectively standardize and structure the coordination and communication of essential information. Despite the extensive study dedicated to improving handoffs, the effectiveness of the developed interventions continues to be scrutinized by both healthcare practitioners and researchers; patient transfers remain a significant source of medical errors in the healthcare system.
These issues are evident during pre-hospital to ED handoffs, particularly highlighted by the negative interactions and outcomes reported by care teams. While the literature on this topic is currently limited, it suggests that poor handoff practices may contribute to increased rates of moral injury, burnout, feelings of being devalued, and instances of missed or lost patient information during transfers. This discussion panel will include a transdisciplinary group of experts who will aim to synthesize the evidence surrounding these interactions, describe initiatives to enhance the socio-technical interactions during these handoffs, and propose a call for further research to assess the potential link to patient safety.
Erik Prytz, Ph.D., Linköping University, Senior Associate Professor.
It is said that a chain is only as strong as its weakest link. The first link in the Trauma Chain of Survival is first aid provided by immediate responders who happen to be near the accident. This is a vital step in the time between an accident occurs and professional first responders arrive at the scene. Educational initiatives such as the Stop the Bleed campaign aim to support these immediate responders by providing training in specific first aid techniques to stop life-threatening bleedings, such as direct pressure or tourniquet application, and empowering them to act in real emergencies. Other educational initiatives, such as most cardiopulmonary resuscitation classes, are similar. These outreach programs are essential, yet questions remain concerning strengthening this first link in the chain. One approach is to incorporate human factors aspects beyond the technical skills, for example, teamwork or communication skills, to enhance the cooperation between multiple immediate responders and between immediate responders and first responders.
Jakob Hanschu, National Farm Medicine Center, Research Specialist and Socio-Cultural Anthropologist.
Agricultural operations are complex sites that often involve non-standard spatial organization and unique hazards, complicating emergency response efforts. Additionally, contemporary members of rural fire departments and other first responders have, on average, less familiarity with agriculture than their predecessors, due to demographic and economic trends. Thus, agricultural emergencies are low-frequency, high-risk events for first responders. Emergency
events such as car crashes or carbon monoxide calls are common, and thus many emergency departments are familiar with these events and highly proficient at responding to them. Agricultural emergencies, on the other hand, are relatively infrequent, so departments are less practiced at responding to them. To increase agricultural emergency preparedness among rural first responders, the National Farm Medicine Center has developed two programs: 1) Rural Firefighters Delivering Agricultural Safety and Health (RF-DASH) and 2) Agriculture Rescue Training (ART). RF-DASH trains rural first responders in agricultural emergency prevention and preplanning as well as farm hazard assessment. ART utilizes simulated agricultural emergency events to provide first responders with hands-on training in the technical rescue aspects of agricultural emergencies. The origins and various components of these two programs will be discussed, highlighting successes and challenges to program implementation. Further, building on the presentation of the ART and RF-DASH programs, the broader potential for simulation- and scenario-based learning in rural and agricultural emergency preparedness training will be discussed.
Yuval Bitan, Ph.D., Ben-Gurion University of the Negev, Associate Professor.
Effective information handover is a critical component of patient care during the transition from the pre-hospital setting (Emergency Medical Services - EMS) to the hospital Emergency Department (ED). The transition of care from EMS paramedics to ED personnel during healthcare handover is marked by a power disparity between these two groups of healthcare providers. As in many other transitions in healthcare the receiving side is considered to be more advanced and sophisticated. The disparity between EMS and ED personnel leads to gaps in the way EMS information is delivered and processed by the ED.
In this panel I’ll present some of the data we collected in a baseline study at one hospital in Israel, and discuss the importance of future research on this topic. Our findings, based on observations and surveys, mainly point to the difference between synchronous (verbal) and asynchronous (printed) information delivery. Furthermore, the study also highlights the missing opportunity to receive from the EMS team unique information about the patient's environment at the time of the call. This encompasses crucial details about the patient's home or the circumstances of the incident that brought them to the ED.
Yui-Yee Raymond Chan, M.D., Children’s Mercy Hospital and University of Missouri Kansas City School of Medicine, Hospitalist and Human Factors Scientist.
Trauma-based interventional care is often described as prescriptive in nature and necessitates accurate quickly relayed, and structured information to inform optimal care decisions at the right time. The majority of trauma-based handoff interventions have been developed under this structure, with tools that nudge pre-hospital staff to provide structured information that feeds into the standardized nature of trauma-based care assessment. This structure, however, may dissolve as the patient encroaches into the threshold from complicated to complex.
Hilligoss and Moffatt-Bruce (2014) argue that many of the issues currently proposed for pre-hospital to ED strategies lend themselves to a causal, logical approach, which in turn misses complex issues that rely on contextual information. In their discussion on the limitation of checklists, Hilligoss and Moffatt-Bruce draw inspiration from the work of cognitive psychologists Jerome Bruner (1986) and Glouberman and Zimmerman (2002), who describe two
methods of thought: the paradigmatic and narrative. These modes of thinking are mutually exclusive and represent different ways information is explained. Paradigmatic or logico-mathematical employs rule-based explanations, like those present in trauma-based assessments, while the narrative mode focuses on understanding human experiences and intentions. We propose an extension of Hilligoss and Moffatt-Bruce's assessment that many handoff initiatives apply these concepts to handoffs but are primarily limited to the paradigmatic mode of thinking. However, my experiences as a provider show that a single handoff may require the inclusion of narrative experiences to communicate both the complicated and the complex information to inform patient care assessments and decisions best. Understanding when to use these modes may benefit future research.
Event Type
Discussion Panel
TimeMonday, March 311:30pm - 3:00pm EDT
LocationPier 9
Simulation and Education (SE)