From the Guidelines
When handing over a deteriorating patient to the paramedical team, it is crucial to communicate vital sign abnormalities, mental status changes, and specific symptoms to ensure continuity of care and facilitate timely interventions. According to the Society of Critical Care Medicine guidelines 1, bedside staff should promptly and accurately acquire and document all vital signs, with significant abnormalities urgently acted upon. Examples of patient deterioration to communicate include:
- Vital sign abnormalities such as hypotension (systolic BP <90 mmHg), tachycardia (heart rate >100 bpm), bradycardia (heart rate <60 bpm), tachypnea (respiratory rate >20 breaths/min), hypoxemia (oxygen saturation <94% on room air), hypothermia (<36°C) or fever (>38°C)
- Mental status changes, including new confusion, decreased consciousness, or Glasgow Coma Scale changes
- Specific symptoms like chest pain, shortness of breath, or new onset seizures
- Recent changes in the patient's condition, such as increasing oxygen requirements, decreasing urine output (<0.5 mL/kg/hr), new arrhythmias on cardiac monitoring, or worsening lab values like rising lactate, abnormal blood gases, or electrolyte disturbances
- Any interventions already attempted, including medications administered (with specific doses and times), fluid boluses given, or respiratory support initiated
It is also essential to empower patients, families, and care partners to recognize subtle differences in clinical status that may signify deterioration and alert appropriate personnel 1. This comprehensive handover ensures that the paramedical team can immediately understand the severity and progression of the patient's deterioration, facilitating appropriate and timely interventions.
From the Research
Patient Deterioration During Handover to Paramedical Team
- Patient deterioration during handover to the paramedical team can occur due to various factors, including ineffective communication and transfer of information 2.
- A study on patient handover in the emergency department found that disrespectful behavior, such as task-orientated behavior and the use of indigenous language, can negatively influence patient handover and ultimately patient outcome 2.
- The concept of handover in nursing involves the transfer of responsibility from one person to another through communication, including the transfer of information, interaction for disambiguation, and context-sensitive strategy 3.
- However, there is limited research specifically on patient deterioration during handover to the paramedical team, and more studies are needed to address this issue.
Examples of Patient Deterioration
- A study on non-invasive ventilation found that cardiac arrest related to NIV occurred in one per 10,000 patients under NIV for ARF treatment, and NIV-related cardiac arrest was associated with NIV failure 4.
- Another study found that septic patients under mechanical ventilation may benefit from adjunctive treatments such as beta-blockers, aspirin, and heparin, but the findings are still controversial 5.
- A systematic review and meta-analysis on the effects of non-invasive ventilation in subjects undergoing cardiac surgery found that NIV failed to reduce the risk of pulmonary complications, but shortened the length of ICU stay and hospital stay 6.
Importance of Effective Handover
- Effective handover is crucial to prevent patient deterioration and ensure continuity of care 2, 3.
- Healthcare professionals should recognize that during patient handover, 'how' is as important as 'what', and involve patients and their significant others in the handover process 2.
- Further research is needed to develop strategies for effective handover and to address the issues related to patient deterioration during handover to the paramedical team.