415 - Perceptual Discordance Between EMS and ED Providers During Pediatric Handoffs: Insights From a Paired Survey Study

Publication Number: 4406.415

Jack R. Crowley, Frank H. Netter MD School of Medicine at Quinnipiac University, Hamden, CT, United States; Richard Feinn Feinn, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, United States; Sharon Smith, University of Connecticut School of Medicine, Hartford, CT, United States

Background: Communication failures during care transitions are a leading cause of medical errors. The EMS-to-ED handoff is particularly vulnerable in pediatrics, where unique physiology, patient communication challenges, and caregiver involvement increase complexity. Prior research has been one sided or used objective measures only, leaving gaps in understanding of handoff quality.

Objective: 1- To evaluate the quality of communication during pediatric EMS-to-ED handoffs through paired surveys to EMS and ED clinicians.
2- To identify discrepancies between EMS and ED provider perceptions of handoff clarity, accuracy, and completeness.
3- To determine commonly perceived barriers to communication.

Design/Methods: This is a prospective, cross-sectional study, conducted in large urban pediatric ED. Following a verbal report, the EMS provider giving report and ED clinician receiving the report are invited to complete the survey. Surveys are role-specific and paired to the same encounter using time and patient identifiers. Captured data includes role, experience, acuity, clarity, accuracy, completeness, respect and communication barriers.

Results: To date, 235 surveys have been completed: 120 EMS, 115 ED, and 200 of these were paired. EMS providers felt less respected (p=0.007) and were more confident in the accuracy of handoffs than ED clinicians (p=0.046). ED staff rated reports to be less clear than EMS (p=0.006) and were also more likely to recall requesting information to be repeated by EMS (p=0.007). Additionally, ED staff rated the overall quality of handoffs lower than EMS providers (p=0.044). Short answer question respondents reported: poor handoff environment (n=9), needing more detailed patient information (n=8), respect/recognition issues (n=7), facility/staff unprepared for EMS arrival (n=6), wanting a written report (n=6), understanding of scope of practice (n=4), and concern for patient privacy (n=4).

Conclusion(s): Significant discordance exists between EMS and ED clinicians during pediatric handoffs. EMS providers report lower perceived respect, greater confidence in their accuracy and greater clarity, while ED clinicians express the opposite. Findings highlight the need for communication structure, emphasizing mutual understanding and standardized handoff frameworks.

Comparison of EMS and ED Provider Perceptions of Handoff Communication Quality
Figure 1. Comparison of EMS and ED provider perceptions of communication quality during pediatric EMS-to-ED handoffs. Mean Likert-scale responses (1-5) are shown for six communication domains. EMS providers reported significantly higher scores for clarity (P = 0.006), confidence (P = 0.046), and respect (P = 0.007) compared with ED staff, while differences in engagement, privacy, and scope were not statistically significant. Error bars represent standard error of the mean.

Differences in Reported Handoff Barriers Between EMS and ED Providers
Figure 2. Proportion of EMS and ED providers reporting selected barriers during pediatric EMS-to-ED handoffs. Responses were dichotomous (yes/no) for each barrier type: time pressure, interruption, and repeat information. ED staff was significantly more likely than EMS providers to report repeated information as a barrier (P = 0.006), while differences in time pressure and interruption were not statistically significant. Error bars represent standard error of the mean.

Comparison of Overall Handoff Quality Ratings Between EMS and ED Providers
Figure 3. Mean overall handoff quality scores reported by EMS and ED providers during pediatric EMS-to-ED transitions, measured on a 1-10 Likert scale (1 = poor, 10 = excellent). EMS providers rated overall handoff quality significantly higher than ED providers (P = 0.044). Error bars represent standard error of the mean.