Physician’s Weekly co-hosted another installment of the #PWChat series on Wednesday, February 28, 2018, with PW blogger Matthew Loxton, MKM, CKM.
The discussion was based on a previous article on whether communication and integration in emergency medicine has improved in the past 30 years since Loxton’s days as an EMT. Topics discussed included whether facts are still lost in the handoff between EMTs/paramedics and emergency department staff, whether time is still wasted in getting ambulance crews turned around, whether there are still missed opportunities for hospital staff to be better prepared for incoming emergency patients, and much more!
View our upcoming schedule, or read our other #PWChat recaps here.
Below are the highlights from the chat. You can read the full transcript here.
Question 1
Q1: Are facts still lost in the handoff between #EMTs/#paramedics and #EmergencyDepartment staff? What contributes to this & how can it be overcome?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
A1 would be interested to hear if salient pt info still gets lost. It used to be a huge frustration that much of what the EMT collected never made it into the pt record at the hospital #PWChat
— Matthew Loxton (@mloxton) February 28, 2018
#PWChat Extension of @AmCollSurgeons ATLS ABCD Primary/Secondary survey/communication method to prehospital (EMS/paramedics) and post-ER providers (Anesthesia/Non-surgical intensivist) would help put everyone on the same page.
— Robert Vance (@WVUpython) February 28, 2018
The ATLS primary survey teaches a systematic and quick way to assess all trauma patients. If the initial provider can competently follow the algorithm, they should be able to communicate clearly all the info to the receiving ER. It’s as simple as ABCDE.
— Robert Vance (@WVUpython) February 28, 2018
A1. Another concern would be information going out of the ER. I sometimes have trouble getting records for a patient that went to the ER. #PWchat https://t.co/EprJWFXyR1
— Linda Girgis, MD (@DrLindaMD) February 28, 2018
Question 2
Q2: Is time still wasted in getting ambulance crews turned around and on to the next call? What contributes to poor turnaround times & how can they be shortened?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
A2 putting EMT crew back into service used to often be a problem. The EMTs typically cannot leave until a formal pt handoff is completed. Poor ED/EMT communication can result in crew hanging about instead of answering next call #PWChat
— Matthew Loxton (@mloxton) February 28, 2018
A2: In our shop, charge nurse and pt nurse take initial report. If possible, I am present as well. Our crews turn around pretty quickly. #pwchat
— Annahieta Kalantari (@akkalantari) February 28, 2018
Question 3
Q3: Are opportunities still missed for #hospital staff to be better prepared for incoming #emergency patients? What contributes to this? What solutions exist?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
This must be one of the biggest improvement opportunities. If EMT crew can signal ahead what their payload is, and ED can start triage and send instructions or queries, pt flow and time to doc are improved #PWChat
— Matthew Loxton (@mloxton) February 28, 2018
A3: Nothing is perfect. Contributers: wanting to get pt to ED asap may sacrifice some on the scenes details. likely unable to get all details with unstable pts. We likely have more time than we think to pause and grab a few more details on both ends.
— Annahieta Kalantari (@akkalantari) February 28, 2018
Question 4
Q4: Are opportunities still missed for #EMS to initiate specific treatment during transport based on feedback from #hospital #EmergencyPhysicians? Why would this still occur/What barriers exist? How can those barriers be knocked down?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
Perhaps another challenge is how to deal with multiple patient in the ambulance? Can easily be 2-3 in the same ambulance. Most I ever saw was 10 in a standard ambulance 😉 #PWChat
— Matthew Loxton (@mloxton) February 28, 2018
Question 5
Q5: Are #hospitals alerted to the specific nature and ETA of incoming patients in enough time to be prepared? If not, why? What barriers exist to this happening in 2018? What solutions exist?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
Maybe a combo of NLP, ruggedized tablet, and medical scribes is needed? Scenes are hectic, back of ambulance is pretty crowded, unstable, and scene-to-ED time pretty short, but there must be ways that improve status quo of 30 yrs ago? #pwchat
— Matthew Loxton (@mloxton) February 28, 2018
Question 6
Q6: Do gaps still exist between what actions #EMS crews take and data they collect and what #EmergencyPhysicians would want? If so, what’s causing them? If not, how’d we overcome these gaps in the last 30 years.#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
A6 another big oppty for process improvement – are EMTs collecting the data ED staff most need, and is there a process for ED to feed back info gaps to EMT org so they can ammend protocols, training etc #PWChat https://t.co/yCJUo8xjQG
— Matthew Loxton (@mloxton) February 28, 2018
Question 7
Q7: Are there feedback loops from #EmergencyDepartments to #EMS crews to inform them of the final diagnosis & provide advice on process improvements? If so, we’d love to know of examples? If not, why? What barriers exist & how do we overcome them?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
A7 tbh, this was probably the #1 gripe EMT crews seemed to have. Sense of loss almost unless you heard back what the outcome was. Vital for EMT stress coping and also for quality improvement. Hope things are better now! #pwchat https://t.co/UaUySQ8fop
— Matthew Loxton (@mloxton) February 28, 2018
Question 8
Q8 Are there still attitude issues that reduce the effectiveness of communication and integration between #EmergencyDepartments & #EMS crews? If so, what needs to be changed & who needs to do that?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
In general I think the communication is good. I don’t encounter any attitude from EMS, and hopefully they don’t think I’m giving them any. There is one issue that is a logistical thing that could be worked out….
— Sandy Simons MD (@ERGoddessMD) February 28, 2018
If possible I love to hear directly from the crew about the patients they are bringing in, so I will often rush in to talk to them before a nurse even gets there. Then the nurse ends up missing some of the report, or EMS ends up giving the report twice.
— Sandy Simons MD (@ERGoddessMD) February 28, 2018
Question 9
Q9 Are there still technology barriers to effective communication and integration between #EmergencyDepartments & #EMS crews? If so, what needs to be changed & who needs to do that?#PWChat
— Physician’s Weekly (@physicianswkly) February 28, 2018
Recently saw an ED inundated by a bus w 30+ pts arriving from regional care centers. Happened around same time each week, but zero warning from the bus beforehand. ED would have loved some sortbofvwarning of ETA and payload#pwchat https://t.co/bRXsoT3gZS
— Matthew Loxton (@mloxton) February 28, 2018
