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Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis

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Abstract

Objective

Patient handover between paramedics and the trauma team is vulnerable to communication errors that may adversely affect patient care. This study assesses the feasibility of a handover tool, IMIST-AMBO (acronym of categories), implementation in the trauma bay and evaluates the degree to which it improves handover metrics.

Methods

This is a prospective observational cohort study conducted at Canada’s largest level-one trauma center. Feasibility of the tool implementation and improvement in handover metrics were assessed. Strategies for implementation included distribution of an educational video and posters, and point-of-care reminders in the trauma bay. Two reviewers independently assessed video recordings of handovers to evaluate handover metrics. Findings were compared to data obtained during a knowledge gap analysis conducted prior to the initiation of this study at the same institution.

Results

Over 13 weeks (August to November 2020), 140 videos were recorded, of which 80 used the IMIST-AMBO tool (compliance of 57%). Paramedic adherence to the handover structure occurred in 70.4% of cases, with greater adherence to the IMIST (82.2%) compared to the AMBO (47.1%) section. The mean (± standard deviation) handover duration was shorter (1 min:58 s ± 0:44 s during implementation vs. 2 min:47 s ± 1:14 s pre-implementation, [p < 0.001]). Frequency of parallel conversations and informal handovers improved (61% to 30% and 65% to 13%, [p < 0.001], respectively). Interruptions during the handover decreased from 3.05 (± 1.95) to 1.5 (± 1.7), p < 0.001. The tool was received favorably among study participants.

Conclusion

The IMIST-AMBO tool reduced the frequency of interruptions, parallel conversations, and informal handovers during paramedic–trauma team handovers at our institution. The quality and amount of information communicated per handover improved, all with a decrease in handover duration. The IMIST-AMBO tool may be applied to other trauma centers across Canada, or more broadly on an international scale.

Résumé

Objectifs

Le transfert des patients entre les ambulanciers paramédicaux et l’équipe de traumatologie est vulnérable aux erreurs de communication qui peuvent nuire aux soins aux patients. Cette étude évalue la faisabilité d’un outil de transfert, IMIST-AMBO (acronyme des catégories), mis en œuvre dans le service de traumatologie et évalue dans quelle mesure il améliore les paramètres de transfert.

Méthodes

Il s’agit d’une étude de cohorte observationnelle prospective menée dans le plus grand centre de traumatologie de niveau 1 du Canada. La faisabilité de la mise en œuvre de l’outil et l’amélioration des paramètres de transfert ont été évaluées. Les stratégies de mise en œuvre comprenaient la distribution d’une vidéo et d’affiches éducatives, ainsi que des rappels au point de service dans la salle de traumatologie. Deux examinateurs ont évalué indépendamment les enregistrements vidéo des transferts pour évaluer les paramètres de transfert. Les résultats ont été comparés aux données obtenues lors d’une analyse des lacunes en matière de connaissances réalisée avant le lancement de cette étude dans le même établissement.

Résultats

Sur 13 semaines (août à novembre 2020), 140 vidéos ont été enregistrées, dont 80 ont utilisé l'outil IMIST-AMBO (conformité de 57%). L’adhésion des ambulanciers paramédicaux à la structure de transfert s’est produite dans 70.4% des cas, avec une plus grande adhésion à l’IMIST (82.2%) que l’AMBO (47,1%). La durée moyenne (± écart-type) du transfert était plus courte (1 min: 58 s ± 0: 44 s pendant la mise en œuvre contre 2 min: 47 s ± 1: 14 s avant la mise en œuvre, p < 0.001). La fréquence des conversations parallèles et des transferts informels s'est améliorée (de 61% à 30% et de 65% à 13%, [p < 0.001], respectivement). Les interruptions pendant le transfert ont diminué de 3.05 (± 1.95) à 1.5 (± 1.7), p < 0.001. L’outil a été accueilli favorablement par les participants à l’étude.

Conclusion

L’outil IMIST-AMBO a réduit la fréquence des interruptions, des conversations parallèles et des transferts informels pendant les transferts de l'équipe paramédicale de traumatologie dans notre établissement. La qualité et la quantité d'informations communiquées par transfert se sont améliorées, tout en réduisant la durée du transfert. L'outil IMIST-AMBO peut être appliqué à d'autres centres de traumatologie à travers le Canada, ou plus largement à l’échelle internationale.

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Data availability

All study data is available upon request.

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Acknowledgements

We would like to acknowledge Taryn Johnston, Darren Gerson, and Sarah-Anne de Groot at Sunnybrook Health Sciences Centre for their contributions in providing statistical analysis support.

Funding

Financial support for this study was $5000.00 awarded from an internal research competition at Sunnybrook Health Sciences Centre called Quality Quest Competition on January 22, 2020.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Western University, London, ON, Canada

    Cara G. Elliott

  2. Tory Regional Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Lowyl Notario, Dylan Pannell, Avery B. Nathens, Homer Tien, Will Thomas-Boaz, Corey Freedman & Luis da Luz

  3. Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Brian Wong

  4. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Arshia P. Javidan, Dylan Pannell, Avery B. Nathens, Homer Tien & Luis da Luz

  5. Toronto Paramedic Services, Toronto, ON, Canada

    Martin Johnston

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  1. Cara G. Elliott
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Corresponding author

Correspondence to Luis da Luz.

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Conflict of interest

The authors declare there are no competing interests.

Ethics approval

Approved by the Research Ethics Board at Sunnybrook Health Sciences Centre.

Consent to participate

Informed consent was obtained from individual participants (Trauma Team Leaders and Nurses) as required by the Research Ethics Board at Sunnybrook Health Sciences Centre.

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Elliott, C.G., Notario, L., Wong, B. et al. Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis. Can J Emerg Med 25, 421–428 (2023). https://doi.org/10.1007/s43678-023-00503-4

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  • DOI: https://doi.org/10.1007/s43678-023-00503-4

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