Improving Communication Between Nurses and Paramedics
May 15, 2014 | Kristyna Culp
Emergency care is by its nature a complex, fast moving world, in which effective communication between members of the care team is vitally important. Todd Smith, a Ph.D. candidate and AG-ACNP student at the University of Virginia School of Nursing, is studying the communication between paramedics and nurses, and looking for ways to improve it. FreemanWhite recently provided Smith with a grant to continue his research, which we believe holds great potential for improving the efficiency of emergency care.
Smith has had an up-close view of the communication disconnect over the course of his career. He first began working as a volunteer firefighter in 1989; he became a paramedic three years later, and a nurse in 1995. He’s worked in volunteer as well as full time capacities, in various pre-hospital environments, as well as part of ED teams.
“As a result of my background,” Smith explains, “I think I have a good feel for what various first responders, including paramedics, firefighters, and EMTs go through. I’ve also worked in both hospital and ED settings, where I’ve worked on cases ranging in acuity from level 3 to level 1. My career has involved many points along the process of emergency care — from bringing patients in from their homes or accident sites, all the way through working with them in the ED and discharging them.”
Smith recently shared that over the course of his career, “I’ve seen significant amounts of wasted time and duplicated efforts. I think it’s often caused by the fact that nurses and paramedics aren’t always able to communicate well with each other.” Smith became determined to help find more effective ways to transition patients from being cared for by the pre-hospital staff (whether first responders, firefighters, or paramedics), to the nurses who receive the patients in the ED.
Trying to Prevent Longer Stays
Smith has seen multiple occasions in which a nurse either doesn’t listen to the medic, the medic doesn’t give a good report to begin with, or both. Whatever the cause, vital information about the patient can be lost, negatively affecting the care they receive in the ED. “In my experience,” Smith observes, “this type of disconnect generally lengthens the patient’s stay unnecessarily.”
Smith, who is scheduled to defend his thesis in Spring 2014, has conducted a literature review of multiple studies that examined paramedics’ ability to communicate with nurses using a triage instrument. He notes that they have generally concluded that paramedics were not successful in using the triage instruments to predict admission or discharge, or adverse or positive outcomes. “The paramedics could make very accurate predictions for the critical patients, such as the victims of shootings or other traumas,” Smith explains. “But they struggled with more vague complaints, such as a pain in abdomen, or more complicated sets of circumstances, such as ‘my leg hurts, I’m on Coumadin, and also have a headache.’”
“I believe that paramedics can help in the triage process — if they’re properly trained,” says Smith. “So I approached the Canadian Emergency Physicians Association about the use of their instrument, the Canadian Triage and Acuity Scale (CTAS). CTAS is a 5-level instrument, much like the Emergency Severity Index (ESI). In Canada, hospitals have adopted CTAS as national standard, and it’s used everywhere. In contrast, although ESI is widely used in the U.S., it’s not yet the standard.”
A few years ago, Dr. Rob Grierson, medical director of Winnipeg Fire and Paramedics Service, worked with colleagues to try to get paramedics in Winnipeg to use CTAS, and see what type of impact doing so might have on their communication with nurses. The researchers had tremendous success, and now there’s a large study underway involving several thousand patients. Smith wanted to mimic that study, but since the U.S. doesn’t have a standard 5-level instrument in universal use, he decided to see if paramedics in this country could also benefit from using the CTAS instrument, and to compare it with the ESI in its ability to predict admission or discharge.
“My hope is to show that paramedics in the U.S. are willing and able to be trained up to a higher standard of care, so they can work more collaboratively with nurses, nurse practitioners, and physicians. I see a future where paramedics work more closely with them, especially in advanced practice roles in acute care situations. To bring about that change, we need to prove paramedics can use the instrument and speak the same language as the nurses.”
ABOUT THE AUTHOR Kristyna Culp MBA
Kristyna creates workflow mapping and computer simulation model frameworks to validate, test, and quantify various scenarios to help clients make informed decisions about both operational and physical design improvements. Read more from Kristyna.