In a typical acute care hospital in the U.S., more than half of critically ill patients arrive by ambulance.[i] Yet the current process of transferring care from emergency medical services (EMS) providers to hospital emergency department (ED) care teams is broken. Years of studies have shown that these handoffs are consistently poor, which has major implications on patient outcomes.[ii],iii It also adds unnecessary administrative costs for hospitals, burdens short-handed staff, and limits the level of claims reimbursement.
There’s no arguing the importance of improving acute care transfers for hospital EDs. The key is to integrate pre-hospital and hospital patient data at each pain point in the transfer process.
The Problems With EMS-to-Hospital Handoffs
The first pain point occurs when EMS crews transfer patient information, typically verbally and manually, to the ED upon arrival at the hospital. About half of handoffs do not record the clinical assessments, physical exams, or vital signs collected by medics in the field.[iii] Hospital staff has mere minutes to absorb fragmented information and make critical decisions about the next steps of care. Furthermore, hospital systems cannot glean any data from a faxed or paper chart or even a PDF, which creates downstream issues for clinicians throughout the continuum of care and creates challenges for measuring and improving performance in compliance with Joint Commission standards.
The next pain point is medical errors that can result from working with these data remnants. Making medical assessments based on an incomplete patient picture means EDs are much more likely to make mistakes, such as misdiagnosis or delayed treatment. These can pose significant risks to patient safety and outcomes, as well as to hospitals from legal and financial perspectives.
Additionally, staff shortages across the healthcare industry are exacerbating problems with acute care transfers and increasing the risks to patient safety. Short-handed EMS crews may pass lower quality patient information to EDs, leaving strained hospital staff to make critical care decisions despite blind spots.
Clearly, the process for acute care handoffs is broken, but there are solutions hospitals can implement to improve these transfers, and in doing so, pave the way for better outcomes, enhanced staff efficiency, and more revenue.
A Better Way To Hand Off Acute Care Patients
Progressive hospital EDs are effectively improving acute care transfers by promoting data interoperability through electronic medical record (EMR) software connected to an automated, bi-directional data exchange platform, such as ZOLL® Care Exchange. This technology securely shares patient data between EMS , the ED, and even cardiac catheterization (cath) labs.
Some cloud-based EMS patient care documentation solutions are built from the ground up to enable bi-directional data transfer between the PCR and the EMR. EMS providers can capture complete and accurate patient information on scene and then automatically communicate essential health, demographic, and insurance data to hospitals via the EMR in real time along with social determinants of health that help providers assess the risk of complications, morbidity, or mortality.
Data interoperability goes beyond charting. “Medical controls at hospitals have real-time remote access to defibrillator data from the field using cellular or Wi-Fi connections,” explains Greg Howard, Director of Hospital Interoperability for ZOLL Data Systems. “EDs can remotely monitor the patient’s vital signs, conditions, and crew interventions in real time. They can initiate live telemedicine sessions and provide guidance to paramedics on how to proceed before the patient arrives. At the same time, EDs can activate the cath lab and alert the appropriate staff for improved door-to-balloon times, and consequently, improved care.”
Data interoperability also enables access to pre-hospital care documentation necessary for proper coding and reimbursement, per the new 2023 CPT® Evaluation and Management (E/M) Code and Guidelines for medical decision making (MDM). ED physicians can refer to EMS reports when deciding treatment, and insurance claims can then be coded correctly, helping to ensure optimal reimbursement.
Benefits of Data Interoperability Throughout the Continuum of Care
With readily available technology to facilitate data interoperability between EMS and EDs, transfer of care need not pose heightened risks for patients and providers alike. Automated, bi-directional data exchange offers numerous clinical, operational, and financial benefits throughout the continuum of care. Now is the time to embrace solutions that unblock the flow of information during acute care handoffs to improve patient outcomes, clinical documentation, compliance, and revenue capture without adding to the considerable strain and administrative burden healthcare providers already bear.
[i] Squire, Benjamin T.; Tamayo, Aracely; Tamayo-Sarver, Joshua. “At-Risk Populations and the Critically Ill Rely Disproportionately on Ambulance Transport to Emergency Department.” Lexipol website, 2010, April 14, https://media.cdn.lexipol.com/ambulance-study.pdf Accessed 13 Nov. 2023.
[ii] Jensen, SM; Lippert, A; Østergaard, D. “Handover of patients: a topical review of ambulance crew to emergency department handover.” NIH National Library of Medicine website, 2013, May 3. https://pubmed.ncbi.nlm.nih.gov/23639134/ Accessed 10 Nov. 2023.
[iii] Goldberg, Scott A; Porat, Avital; Strother, Christopher” G; Lim, Nadine Q; Wijeratne, H R Sagara; Sanchez, Greisy; Munjal, Kevin G. “Quantitative Analysis of the Content of EMS Handoff of Critically Ill and Injured Patients to the Emergency Department.” NIH National Library of Medicine website, 2016, Jul. 15, https://pubmed.ncbi.nlm.nih.gov/27420753/ Accessed 9 Nov. 2023.