215 - Quality Improvement Initiative to Improve EMS (Emergency Medical Services) Handoff for Critically Ill Pediatric Patients

Poster Number: 215
Publication Number: 215.1814

Background: The handoff of critically ill children from Emergency Medical Services (EMS) to Emergency Department (ED) providers is a crucial transition, however limited training and frequent interruptions increase the chance of error. Deficiencies are well documented in the care of adults, but there is limited literature in pediatrics.

Objective: 1. Evaluate EMS to ED handoff by video review using a standardized form.
2. Determine the effect of implementation of a standardized handoff model on the performance of EMS to ED handoff.

Design/Methods: We conducted a retrospective review of videos of EMS to ED handoffs at an academic pediatric level 1 trauma center from July 2021 to July 2023. All encounters in our trauma bay are video recorded for quality review as standard-of-care. A grading tool including 15 data points was utilized to evaluate handoff quality in communicating information between EMS and the ED. Handoffs were evaluated via video review for duration, data presented, and interruptions. We provided education to EMS agencies and ED personnel on the D-MIST handoff model, (Figure 1), a validated and widely used handoff tool.
EMS pre- and post-intervention groups were compared using generalized estimating equation regression for count data and linear mixed model for continuous data. ED data were compared between groups using negative binomial regression analysis.

Results: We provided asynchronous video education to nine EMS agencies in our region and our ED staff. We compared 31 encounters from these agencies pre-education and 37 post-education; we also compared these to 31 encounters from agencies who did not receive education. On EMS agency level, there was no statistically significant difference between post-intervention and pre-intervention in the total number of missing data elements (0.19 vs. 0.37; rate ratio, 0.51 (95% CI 0.21 to 1.24); p=0.137) and the handoff duration (62.8 vs. 68.3 seconds; difference, -5.5 (95% CI -21.2, 10.3); p=0.4893). We compared the 31handoffs which occurred before our ED received D-MIST education to post-education 68 handoffs. The number of ED interruptions decreased from 1.74 to 1.47 with rate ratio, 0.84 (95% CI 0.60, 1.18) and p=0.316.

Conclusion(s): To our knowledge, this is the first evaluation of implementation of a standardized handoff model in a pediatric ED. We observed deficiencies in the EMS to ED handoffs, however, did not see a statistically significant improvement in handoff quality after implementation of D-MIST. Research in implementation and education surrounding EMS to ED transfer is needed.