Patient Safety: How to Improve the Patient Handoff Process

Patient exiting ambulance

The patient handoff process is one of the most critical moments for patient safety in an emergency department. When emergency medical services personnel arrive at your door with a patient, challenges will arise, and an appropriate response by Emergency Department staff is necessary for a successful handoff.

When it comes to an EMS-to-ED handoff the greatest challenges lie in communication. There’s an increased potential for miscommunication — or lack of communication — that can have dire consequences for the patient.

Researchers recently evaluated 90 patient handoffs, studies of which have been limited when it comes to components of quality care. Looking at communication between EMS personnel and ED staff during the handoff, researchers found that EMS personnel provided ED staff:

  • Information related to the patient’s chief concern 78 percent of the time;
  • A description of the scene in 58 percent of all handoffs;
  • A complete set of vital signs in 57 percent of instances;
  • A description of physical exam finding for 47 percent of patients;
  • An overall assessment of the patient’s clinical status in 31 percent of cases.

Researchers did note that handoffs between certified paramedics and ED staff resulted in higher instances of communication of vital signs and physical exam findings, and that paramedics offered an overall assessment more than twice as often than other levels of EMS staff such as EMTs.

This study confirms that there is significant room for improvement during the handoff process of critically ill and injured patients, researchers concluded.

So how can the process be improved in order to provide patients with the high quality of care they expect from EMS providers and ED staff?

Another study looking at this same topic found that EMS providers often saw themselves “as advocates for their patients during the challenging EMS-to-ED handoffs.” And they, in turn, offered four strategies for improving the handoff process, some of which address issues related to communication, while others addressed EMS and hospital protocols that make handoffs more challenging.

Tactics EMS providers suggested include:

  1. “Communicate directly with the ED provider responsible for the patient’s care.”
  2. “Increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers.”
  3. “Standardize some (but not all) aspects of the handoff.”
  4. “Harness technology to close gaps in information exchange.”

While these solutions offered by EMS providers have the potential to be effective ways to improve the handoff process between EMS and ED providers, buy-in would be necessary from the ED standpoint.

Do you think these solutions are reasonable? What can emerFgency departments do on their end to help facilitate a safe, high-quality handoff experience for patients? I’d love to hear your thoughts. Comment below or feel free to drop me a line.


Prehospital Emergency Care: “Quantitative Analysis of the Content of EMS Handoff of Critically Ill and Injured Patients to the Emergency Department.”

Annals of Emergency Medicine: “Optimizing the patient handoff between emergency medical services and the emergency department.”