Clinical handovers by paramedics in the emergency department: a focused ethnographic study in an urban hospital in Northeastern Ontario

Abstract

Clinical handover is a high-risk communicative process that involves the exchange of clear and concise patient-focused information between healthcare providers during the transfer of professional responsibility and accountability for patient care. When a patient is transported to hospital by Emergency Medical Services the trajectory of their care in the emergency department is influenced by the clinical handover given by a paramedic to a registered nurse. A focused ethnographic study was conducted to explore the process of Emergency Medical Service clinical handover within the emergency department of a small urban hospital in Northeastern Ontario from the perspective of the paramedic. The findings revealed paramedic handover was influenced by the communication context including attitude of attention and assurance, both reflected in the professional dynamic between the paramedic and ED staff; the ambience of the ED reflected in the physical layout and activity level of the ED; and the patient acuity reflected in the assigned Canadian Triage Acuity Scale level and frequency of individual visits to the ED. The study provides evidence that paramedics strive to deliver concise, accurate communication of a clinical handover so that ED patients receive safe, competent care and that there is opportunity to improve on the organizational and cultural practices of clinical handover in the ED.