Ep 74 - ED Handover in the resus room: A panel discussion at SMACC DUB. (Part 2)

  Effective Trauma Handovers: Best Practices and Key Considerations Trauma handovers are critical transitions in patient care, transferring responsibility from pre-hospital teams to in-hospital teams. These moments are crucial for ensuring patient safety and the continuation of effective treatment. This summary explores the best practices for trauma handovers, focusing on preparation, timing, communication, and the integration of feedback. Preparation: Utilizing Golden Time Effective trauma handovers begin with thorough preparation. The period between receiving the notification of an incoming trauma patient and their arrival is often called "golden time." This time should be used to organize and prepare the multidisciplinary team, including in-patient specialists, ED staff, nurses, doctors, and radiologists. Key preparatory steps include: Role Allocation: Assign clear responsibilities, such as the trauma team leader, scribe, airway manager, and primary survey conductor. It is crucial to ensure that team members are both competent and confident in their assigned roles, as these attributes, while related, are distinct. Predictive Planning: Use pre-hospital information to anticipate the patient's needs. For instance, a report of a patient with a chest stab wound and hypotension suggests the need to prepare for a thoracotomy. Timing and Coordination Timing is essential in trauma care, particularly in avoiding early calls to the trauma team. At Southampton, the recommended practice is to call the team together approximately 15 minutes before the patient’s expected arrival, avoiding exact time estimates. This strategy helps maintain team readiness and focus. The risks of early calls include loss of focus due to prolonged waiting and the potential for team members to become distracted by other tasks. Conducting the Team Briefing A comprehensive and unified briefing is vital upon the trauma team’s assembly. This briefing should involve the entire multidisciplinary team, preventing any division into subgroups and ensuring that all members receive the same information. A good practice is for team members to introduce themselves using first names, which helps break down hierarchical barriers and fosters a collaborative environment. The briefing should also include a mission rehearsal, outlining the specific tasks and roles each member will perform upon the patient's arrival. The Handover Process The actual handover begins when the patient arrives. The in-hospital team leader should introduce themselves to the pre-hospital team and determine if the patient is stable enough for a hands-off handover. This approach, modeled after military practices, ensures that the handover is conducted calmly and clearly. If the patient is unstable, the pre-hospital team should continue leading the resuscitation until it is safe to hand over control. A structured framework, such as AppMist (Age, Time of injury, Mechanism, Injuries, Signs, and Treatments), should be used to deliver concise and critical information during the handover. This approach ensures that only the essential information is communicated, focusing on the most pertinent details for the ongoing treatment. Addressing Pre-Hospital Challenges The pre-hospital environment is inherently stressful and challenging, with limited resources and a high cognitive load. Pre-hospital teams often face the dual pressures of managing critically ill patients and communicating effectively with the receiving hospital. It is crucial for in-hospital teams to recognize these challenges and refrain from criticizing or undermining pre-hospital efforts during the handover. Instead, the focus should be on receiving and clarifying the necessary information to continue patient care. Pre-hospital teams should aim to deliver concise, relevant information during the handover. Ending the handover with a clear statement, such as "That completes my handover," followed by an offer to answer any