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Research project: Improving the quality of ambulance crew hand-overs

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Ambulance crews are a vital link in the chain of emergency health care. They provide immediate care for very sick or injured people. They make over 3 million patient journeys a year, each of which requires the ‘handover’ or transfer of a patient to the hospital staff. Crews need to give information about the patient to nurses, doctors and other staff during the journey and when they arrive at hospital. This study will follow ambulance crews to understand and describe hand-overs to see how they can be improved . We will use videoing, observation, interviews and records to follow a series of patient journeys and the different pieces of information that are transferred. By understanding how handovers are done we will be able to see how they can be improved to benefit patient care. We will be feeding back our findings directly to Ambulance Trusts and other parts of the NHS to inform professional practice and education.

Ambulance crews play a vital role in urgent care, making 3.6 million emergency patient journeys a year. Patient transfer relies on the verbal, non-verbal (e.g. gestures) and documentary 'handover' of information. Some research has looked at communication during transfer of care from one professional to another, and weaknesses in ambulance hand-overs have been noted (Bruce & Suserud 2005). Handover formats in resuscitation have been proposed to improve information transfer, but standardisation has not been shown to improve verbal accuracy (Talbot & Bleetman 2007). Failure to communicate accurate and salient information threatens patient safety, quality and efficiency of care, yet little is known about hand-over processes and it is therefore difficult to see how handover might be improved.

The aim of this study is to understand how the process of handover influences the transfer of patients to hospital care and impacts on the safety, quality and efficiency of patient care. This study will employ an ethnographic case study design using qualitative observation, interviews and documentary analysis to:
i) provide a unique and detailed description of the handover process including the patient and relatives perspective
ii) compare the content and use of written and verbal information
iii) critically examine information transfer and its impact on safety, quality and efficiency of care
iv) disseminate findings to inform local and national practice and education

This ethnographic case study will follow ambulance crews in a Trust covering a large geographical area in the South Central SHA with city, suburban and rural populations. We will combine real-time video recording, observation, interviews and documentary analysis to understand handover processes. Observation will be structured to reflect temporal and spatial variation. Approx 25 interviews will be conducted with key stakeholders (including patients and relatives/carers) alongside informal conversations during fieldwork. Records and computerised information will be examined. These data will be combined and analysed to examine how different kinds of information are used, transferred and impact on patient care.

Project team

Emma Rowland Research Fellow

Dr Robert Crouch, Consultant Nurse, Emergency Department SUHT
Steve Murray, Emergency Care Practitioner, SCAS, and Postgraduate student

Project funder

NIHR RFPB Programme


Associated research themes

Ambulance services; communication; emergency care; patient journey; handover; patient transfer;

Related research groups

Health Work and Systems
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