Does Your EMS-ED Patient Handoffs Process Need a Hand?

Patient handoffs continue to present challenges and risk to hospitals.
In fact, according to the Joint Commission Center for Transforming Healthcare, “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.” For patients brought to the hospital by ambulance, care actually begins with “first medical contact” by Emergency Medical Services, which adds additional layers to the handoff issue. From the time the 911 call is placed to the time the patient is treated by a physician or specialist team (as is the case for lifesaving time-sensitive acute care such as STEMI, Stroke, Trauma or Sepsis), information has changed hands up to eight times. Each handoff compounds a very large (and very concerning) margin for error. Remember playing “Telephone” as a child? One person whispered a statement to another person, who passed it along to the next… by the time the 4th person received it, it was hilariously different than the original message. Well, in a life or death situation, there’s nothing hilarious about inaccurate or missing information.

Let’s examine the chain of care-related information.
A call is made to 911- a brief background of the patient’s emergency and situation are given to the dispatcher, who passes that info along to the EMS ambulance responding. First responder paramedics and EMTs arrive at the scene, assess the patient, obtain a history and initiate care. They gather additional data and vitals, select the destination hospital and prepare for transport. At some point EMS either consults with a hospital-based nurse or physician for medical direction or simply calls or radios in a summary as a notification to the receiving emergency department. This patient report is (hopefully) passed to other ED staff in advance of the ambulance arrival. That’s handoff number three already and the patient has not yet arrived. Upon arrival, the patient is handed off to waiting nursing staff, who collect a rehash of the care summary from EMS before they leave. As ED providers take over patient care, nurses pass all of this data to arriving physicians, usually reiterated verbally or via jotted notes- from which treatment ensues. For acute care cases, there are yet additional time-sensitive handoffs to CT-Scan or Cath-Lab, and to specialists from cardiology, neurology, and trauma.

Was it a bit tricky to follow all of that?
Seems pretty easy for details to get lost in translation, doesn’t it? This is not a new issue, which is why the patient handoffs between EMS and the ED is termed “a critical moment in patient care” in a recent NAEMSP blog. With today’s emphasis on patient outcomes and reducing cost and risk, the use of Mobile Telemedicine, HIPAA secure notifications, and digital forms are viable, cost-effective tools to drastically reduce that error percentage. Which brings us back to the question. Does your EMS-ED handoff process need a hand?

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How Can You Adapt To Live With Essential Tremor?

Essential tremor is the involuntary shaking of the hands, head, jaws, and voice, which causes frustration, helplessness, and embarrassment for the patients. There is no specific cause yet defined for essential tremor, which is why there is no prevention for it. Moreover, it also doesn’t have a permanent cure. However, based on the diagnosis and symptoms, doctors prescribe certain drugs, therapies, and surgeries that can control the symptoms of the disorder for a certain period of time, without permanently curing it.

Diagnosis of essential tremor

Correct diagnosis is the first step towards appropriate treatment of essential tremor. Also, ruling out other causes is the diagnostic tool. For example, having a blood test cannot determine whether you are suffering from essential tremor, but it can help in ruling out other serious conditions like thyroid that could be responsible for the tremors and be shaking. Neurological exams can check your responses and reflexes to sensations. Thus, it is very important that the right tests are done so that apart from your tremors, other significant diseases can also be checked for. And for this, you need an expert professional. While there are many doctors and neurologists that may help here, but the best person to approach is a movement disorders specialist. Such specialists have received additional 1-2 years education and training in handling such movement disorders, apart from the studies that general neurologists do; thus, making them the ideal person to approach in case of essential tremor or any such ailments.

Treatment of essential tremor

The first steps to take for treating include medications and therapies. Beta blockers and anti-seizure drugs are given to patients, along with simple exercises to follow. They are also asked to stay relaxed by undergoing massages and therapies. Additionally, patients are advised certain dietary and lifestyle changes like avoiding alcohol and caffeine, using heavier utensils and glasses, wearing wrist weights, using heavier writing tools, etc. In short, you need o do everything possible to eliminate things that can make your symptoms worse. Other therapies that can improve your muscle strength, control and coordination are also taught and prescribed. All of this won’t improve your condition, but it will teach you how to adapt to living with essential tremor. Alternative treatments like acupuncture and hypnosis are being researched upon whether they can prove effective for essential tremor patients or not. Whatever therapies you wish to adopt your lifestyle, make sure to consult your doctor for the same. Knowing your health condition, medical history, genetic health, body type, age, etc. can help the doctor decide better which particular type of treatment and therapy is best for you. He may also have you experiment with different methods to help you find the right one for your condition. Therefore, whatever you do, you need to consult a right professional to help you with your condition.