mobilizes and prepares
to meet patient
clears CT scan
prepares for initial critical
intervention if needed
prior to arrival PHARMACY
prepare for possible
PATIEN T ARRIVES
directly to C T SCAN
S TROKE PATIEN T
NEUROLOGISTS and NEUROINTERVENTIONALIST
review patient information
system of care, from first responder to neurologist, typically has access
to multiple mobile devices, yet we don’t take advantage of those technologies to deliver safer care to our sickest patients.
4. Close the loop. One of the most frustrating aspects of emergency
care can be rarely finding out what happens to a patient after you
treat them. This is true for EMS personnel and sometimes even ED
staff, who might transfer a patient to a specialty care center and never
receive follow-up. This final step in the communication process isn’t
just about satisfying their curiosity.
Take a new medic who’s deciding whether or not to activate an
entire system of care for a STEMI patient. Providing near real-time
feedback might be the best way for him—or any provider—to continuously improve and gain the confidence needed to make those lifesaving decisions again and again for his patients.
Lastly, closing the loop helps make everyone involved in the care
process feel like they’re part of a team within a system of care, encouraging further collaboration and cooperation.
Though the total impact of miscommunication between caregivers
during treatment of time-sensitive emergencies is unknown, evidence
points to a high likelihood that communication errors occur and lead
to delays and other negative outcomes.
No single solution to preventing medical errors exists, and the best
interventions focus on creating a culture of safety and collaboration. 8
Any solution needs to start with improving communication among
the many different members of the care team. EMS agencies can be
the driver behind change, bringing members of the regional system of
care together to ensure everyone is on the same page. JEMS
James Woodson, MD, is an emergency physician in Bozeman, Mont., and founder and CEO
of Pulsara, for which he received a 2016 EMS10: Innovators in EMS award.
E. Stein Bronsky, MD, is medical director for the Colorado Springs Fire Department and AMR
in El Paso County, Colo.
1. Makary MA, Daniel M. Medical error: the third leading cause of death in the US. BMJ. 2016:353(i2139).
2. U.S. Department of Health & Human Services. (December 2003.) AHRQ’s patient safety initiative:
Building foundations, reducing risk. Agency for Healthcare Research and Quality Archive. Retrieved
Nov. 20, 2017, from http://archive.ahrq.gov/research/findings/final-reports/pscongrpt/psini2.html.
3. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient
Saf. 2013: 9( 3);122–128.
4. The Joint Commission. (n.d.) Sentinel event data: root causes by event type 2004–2015. HNX
Healthcare Update. Retrieved Nov. 20, 2017, from https://hcupdate.files.wordpress.com/2016/02/
5. Goldberg SA, Porat A, Strother CG, et al. Quantitative analysis of the content of EMS handoff of critically ill and injured patients to the emergency department. Prehosp Emerg Care. 2017: 21( 1); 14–17.
6. Meisel ZF, Shea JA, Peacock NJ, et al. Optimizing the patient handoff between emergency medical
services and the emergency department. Ann Emerg Med. 2015:65( 3);310–317.
7. Richardson M, Rankin C. Abstract NS11: Using a template in the electronic medical record to improve
communication between emergency medical services and the emergency department for acute
stroke. Stroke. 2016: 47(ANS11).
8. Singer SJ, Vogus TJ. Reducing hospital errors: interventions that build safety culture. Annu Rev Public
Health. 2013: 34;373–396.
Figure 1: Patient-centered healthcare communication
Sending critical patient information to all members of the team, at the same time, reduces opportunities for communication errors. All
departments have the important data they need, and can work in parallel, to provide the appropriate care in the most effective way.