Clinical handover by Emergency Medical Services (EMS) staff, as the first people who have contact with trauma patients, in the emergency department (ED), is very important. Therefore, effective communication to transfer clinical information about patients in a concise, rational, clear, and time-bound manner is essential. In Iran, the transfer of necessary information in clinical handover in EDs was carried out orally and without following standard instructions. This study aimed to audit the current clinical handover according to the Identify, Situation, Background, Assessment, and Recommendation (ISBAR) tool and survey the effect of training the ISBAR tool to Emergency Medicine Assistants (EMAs) and EMS staff on improvement of the clinical handover of patients to the ED.

This is a clinical audit study in three phases in Imam Hossein Hospital (Tehran, Iran) during 2016. In the first phase, the clinical handover between EMS staff and EMAs for 178 trauma patients admitted to the ED using ISBAR was audited and information was recorded. In the second phase, the correct approach of clinical handover according to the ISBAR tool was taught to EMS staff and EMAs using pamphlets and lectures. In the third phase, again, the clinical handover between EMS staff and EMAs for 168 trauma patients admitted to the ED was audited using the ISBAR tool and information was recorded. At the end, clinical audit assessment indicators of handover were evaluated before and after training.

Clinical audit of the current situation in the ED showed that the clinical handover process does not follow standard ISBAR (0.0%). However, after training, 65.3% of clinical handover processes were performed in accordance with ISBAR. In the current study, there was an increase in all parameters of the ISBAR tool after training, most of which increased significantly compared to the first phase of the study (before the intervention).

Findings demonstrate that patient handover in the ED did not initially follow the ISBAR standard guideline. After providing education as pamphlets and lectures to EMS staff and EMAs, a high percentage of patient handovers were conducted in accordance with the ISBAR instructions.

Fahim YeganeSA, ShahramiA, HatamabadiHR, Hosseini-ZijoudSM. Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients. Prehosp Disaster Med. 2017;32(5):541–547.

Circumstances surrounding the prehospital management of trauma patients may mask clinical signs of inadequate oxygenation. Pulse oximetry (PO) may influence airway management prior to helicopter transport by helping to identify patients with occult hypoxemia.

Patients were enrolled in a prospective study. Initially, the flight physician clinically decided how best to manage the patient's airway prior to helicopter transport. The patient's oxygenation saturation (O2at), was determined by PO. Then, the physician reassessed the initial airway management decision based on clinical assessment and knowledge of the O2Sat. All patients had an arterial blood gas (ABG) measurement taken after completion of transport.

Sixty patients were enrolled. Knowledge of the O2Sat, as determined by pulse oximetry, did not influence airway management. No patients with occult hypoxemia were identified.

The use of PO in the initial evaluation of trauma patients prior to helicopter transport did not influence the flight physician's initial management of the airway.