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A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

Darren Flynn Orcid Logo, Richard Francis, Shannon Robalino, Joanne Lally, Helen Snooks Orcid Logo, Helen Rodgers, Graham McClelland, Gary A. Ford, Christopher Price

BMC Emergency Medicine, Volume: 17, Issue: 1

Swansea University Author: Helen Snooks Orcid Logo

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DOI (Published version): 10.1186/s12873-017-0118-5

Abstract

BackgroundAmbulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes migh...

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Published in: BMC Emergency Medicine
ISSN: 1471-227X
Published: Springer Science and Business Media LLC 2016
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URI: https://cronfa.swan.ac.uk/Record/cronfa63476
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Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction).MethodsWe conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured strategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics, emergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i) generic or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii) paramedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in secondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.ResultsWe did not identify any studies that evaluated the health impact of an emergency ambulance paramedic intervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage which reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced paramedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer location. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration of treatment) might supplement handover information; (ii) structured handover tools and feedback on handover performance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of paramedics after arrival at hospital was limited to ‘direct transportation’ of patients to imaging/specialist care facilities.ConclusionsThere is insufficient published evidence to make a recommendation regarding condition-specific handovers or extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 63476 2023-05-16 A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2023-05-16 HDAT BackgroundAmbulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction).MethodsWe conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured strategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics, emergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i) generic or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii) paramedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in secondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.ResultsWe did not identify any studies that evaluated the health impact of an emergency ambulance paramedic intervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage which reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced paramedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer location. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration of treatment) might supplement handover information; (ii) structured handover tools and feedback on handover performance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of paramedics after arrival at hospital was limited to ‘direct transportation’ of patients to imaging/specialist care facilities.ConclusionsThere is insufficient published evidence to make a recommendation regarding condition-specific handovers or extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes. However, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced paramedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required. Journal Article BMC Emergency Medicine 17 1 Springer Science and Business Media LLC 1471-227X 1 12 2016 2016-12-01 10.1186/s12873-017-0118-5 http://dx.doi.org/10.1186/s12873-017-0118-5 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 2023-05-30T14:09:26.2218514 2023-05-16T13:33:40.4414469 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Darren Flynn 0000-0001-7390-632x 1 Richard Francis 2 Shannon Robalino 3 Joanne Lally 4 Helen Snooks 0000-0003-0173-8843 5 Helen Rodgers 6 Graham McClelland 7 Gary A. Ford 8 Christopher Price 9 63476__27638__6c13caa41b5c4261bfd2bbc6204b229b.pdf 63476.pdf 2023-05-30T14:08:09.9096743 Output 694912 application/pdf Version of Record true Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. true eng http://creativecommons.org/licenses/by/4.0/
title A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
spellingShingle A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
Helen Snooks
title_short A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
title_full A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
title_fullStr A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
title_full_unstemmed A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
title_sort A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients
author_id_str_mv ab23c5e0111b88427a155a1f495861d9
author_id_fullname_str_mv ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
author Helen Snooks
author2 Darren Flynn
Richard Francis
Shannon Robalino
Joanne Lally
Helen Snooks
Helen Rodgers
Graham McClelland
Gary A. Ford
Christopher Price
format Journal article
container_title BMC Emergency Medicine
container_volume 17
container_issue 1
publishDate 2016
institution Swansea University
issn 1471-227X
doi_str_mv 10.1186/s12873-017-0118-5
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url http://dx.doi.org/10.1186/s12873-017-0118-5
document_store_str 1
active_str 0
description BackgroundAmbulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction).MethodsWe conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured strategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics, emergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i) generic or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii) paramedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in secondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.ResultsWe did not identify any studies that evaluated the health impact of an emergency ambulance paramedic intervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage which reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced paramedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer location. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration of treatment) might supplement handover information; (ii) structured handover tools and feedback on handover performance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of paramedics after arrival at hospital was limited to ‘direct transportation’ of patients to imaging/specialist care facilities.ConclusionsThere is insufficient published evidence to make a recommendation regarding condition-specific handovers or extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes. However, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced paramedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required.
published_date 2016-12-01T14:09:24Z
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