P2.169: Improving Provider Presence at EMS Handoffs in a Pediatric Emergency Medicine Department

Purpose/Objectives: ACEP policy clearly defines processes for communication of key information from EMS to ED providers and are critical to improving patient safety, reducing medicolegal risk, and integrating EMS within the health care system. However, within our 130,000 visit/year tertiary care pediatric ED, provider (MD/PA/NP) attendance at EMS handoffs remains low. While developing interventions to increase provider attendance we sought to 1) accurately measure provider attendance at handoffs, 2) identify which factors affected provider attendance and 3) characterize stakeholder attitudes toward provider attendance at handoffs.

Design/Methods: Provider handoff presence was added to EHR triage forms to accurately measure attendance. Provider attendance and patient demographics (mode of arrival, patient acuity (by ESI), gender, age, ethnicity, race, and final disposition) were obtained from EMR for all EMS handoffs performed in the emergency department between 7/1/24-11/8/24. Chi square analyses were performed using SPSS. Additionally, an email survey was sent to providers, nurses, and EMS staff eliciting opinions regarding the importance of provider attendance at EMS handoffs.

Results: From 7/1-11/8/24 there were 2743 EMS handoffs in the pediatric ED with 62% attended by a provider. There was higher attendance with ALS (342/849, 40.3%) vs. BLS (223/808, 27.6%) or transport team (241/847, 28%) (p < 0.001). There was greater attendance with higher acuity patients: (ESI 1- 15/16, 93.8%; 2- 320/846, 37.8%; 3- 414/1483, 27.9%; 4- 54/151, 35.8%; 5- 3/8, 37.5%) (p < 0.001). Patent ethnicity, race, and age did not correlate with attendance. Survey results demonstrated “ambivalence” among nurses (56%, 9/16) and providers (42%, 8/19), yet 36% (37/102) of EMS staff felt it was “important”. Physician reasons for attending handoffs included obtaining more accurate (29%, 8/28) and additional information (21%, 6/28). EMS and nurses felt it was not important for providers to attend unless the patient was acute (3/135, 24% and 10/38, 26% respectively).

Conclusion/Discussion: EMS-provider handoffs are low in this institution’s pediatric ED. Further work should explore what drives providers to attend some EMS handoffs and what providers deem critical to optimal communication. Improvement cycles will target include meeting presentations, email follow-up, and nursing contact of providers for all ESI 1 and 2 arrivals.