Page 80 - JSOM Winter 2023

Internal Team Handoff for improvement. 4,14,15 When evaluating the quality of patient
The fastest internal team handoff occurred with both Blue- handoffs of critically ill and injured patients that were either
tooth methods of communication (Bluetooth VOX, mean directly observed or recorded with subsequent review, Gold-
22.19 [ range 12.13–30.98] seconds; and Bluetooth PTT, mean berg et al. found very poor quality in patient handoffs from
22.44 [range 14.32–53.69] seconds). Bluetooth VOX, Blue- emergency medical services (EMS) to emergency medicine
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tooth PTT, and radio PTT (mean 31.31 [range 16.36–54.28] physicians. Similarly, Benner et al. found that EMS patient
seconds) were significantly faster than TM-ICS (mean 41.33 handoffs included only 44% of pertinent data, with only 51%
[range 30.21–46.70] seconds; p<.001 ANOVA; p<.001 Blue- of physicians being satisfied with the overall patient handoff. 16
tooth VOX vs. TM-ICS, p<.001 Bluetooth PTT vs. TM-ICS,
p<.01 radio PTT vs. TM-ICS, Bonferroni) (Table 2). Bluetooth There is evidence that the quality of the patient handoff im-
VOX was also significantly faster than radio PTT (p<.001 proves the delivery of care to the trauma patient. When the
ANOVA; p<.01 Bluetooth VOX vs. radio PTT, Bonferroni) MIST report (Mechanism, Injuries, Signs (vitals), and Treat-
(Table 2). ments) was instituted as standard practice for EMS transport-
ing patients to a single level 1 trauma center, Maddry et al.
Patient Handoff Preference found a correlation with improved inpatient records report-
A Bluetooth method of communication was preferred by all ing accurate prehospital interventions to include fluids ad-
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study participants based on clarity and ease of use. Bluetooth ministered and vitals. Ultimately, this resulted in an overall
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PTT was the preferred method (75% ranked first, 25% ranked improvement in the patient handoff experience. Similarly, an
second), with Bluetooth VOX being the next preferred method analysis of videos obtained during patient handoffs by EMS
of communication (25% ranked first, 50% ranked second) found a correlation between EMS MIST report completeness
(Table 3). and high performance by the receiving trauma team. 9
TABLE 3 Preference of Communication Method for a Patient These data are extremely relevant for trauma program medical
Handoff directors, both in the military and in civilian practice, and re-
Method of communication, inforce the importance of standardized communication during
% of participants the patient handoff. This can include the format in which the
Preference Bluetooth Bluetooth information is delivered, so the receiving team can anticipate
rank Radio PTT TC-ICS PTT VOX and respond appropriately to optimize care. This also has spe-
1st 0 0 75 25 cific relevance for the small surgical teams that are far forward
2nd 0 25 25 50 in combat or austere environments. While some of these sur-
3rd 50 50 0 0 gical teams have extensive training in communication in the
4th 50 25 0 25 tactical or austere environment, which includes demonstrat-
Bluetooth VOX = Bluetooth voice operated transmission; PTT = push- ing proficiency in the various methods of communication, the
to-talk; TC-ICS = tactical medic intercom. majority do not. This lack of training could impact patient
care in a sound-restrictive environment or one with significant
Background Noise background noise.
The average background noise with the rotary-wing aircraft
APU on level 2 was higher when measured at the ramp (mean One potential barrier to an optimal patient handoff is back-
116 [range 113.7–118.9]dB) compared with the average back- ground noise in the emergency department. In fact, recom-
ground noise inside the aircraft where the surgical team was mendations have even been made to measure decibel levels
positioned (mean 97.8 [range 95.7–100.5]dB). frequently, ensuring they remain below a certain threshold in
common patient handoff areas to improve the overall quality
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Discussion of the handoff. Compared with a loud emergency room, there
are more significant obstacles in obtaining a quality patient
This study demonstrated that the use of Bluetooth technology handoff in the combat environment. For example, during the
for patient handoff communication resulted in faster patient recent conflicts in Afghanistan and Iraq, over 85% of com-
handoffs in a scenario involving a two-stage handoff when bat casualties were evacuated from POI via aircraft, with
compared with conventional methods of communication rotary-wing aircraft being the most common mode of trans-
(radio PTT or TM-ICS) without sacrificing accuracy during portation. It is common practice for all medics in the field
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high levels of steady state noise. When considering single-stage and rotary-wing aircraft personnel to wear hearing protection.
handoffs occurring immediately outside of the aircraft, al- However, it is important that the hearing protection worn does
though both Bluetooth groups resulted in slightly faster pa- not provide a barrier to communication. This is especially im-
tient handoff times, the difference in time was not significant. portant when it is already known that military rotary-wing
The participants—medical providers experienced in using all pilots have reported that background noise is a common prob-
four methods of communication across the range of medical lem in consistent radio communication. 17
operations—ranked Bluetooth patient handoffs, specifically
Bluetooth PTT, as the preferred method of communication be- It is important to understand the reasons why the use of Blue-
cause of the overall clarity of transmission. tooth communication, both Bluetooth PTT and Bluetooth
VOX, on the fielded headsets were the preferred method of
As the delivery of medicine and trauma care continues to im- communication during the patient handoff. The common
prove, all aspects of care across the entire continuum of care reason provided was clarity of communication, specifically
serve as an opportunity for critical study. The patient handoff with Bluetooth PTT, but there are several additional reasons
has recently received significant attention because of its associ- for the preferences described that must also be noted. First,
ation with adverse medical events and perceived opportunities the Bluetooth VOX setting allows for completely hands-free

78 | JSOM Volume 23, Edition 4 / Winter 2023