ATMIST: Patient Handovers
The introduction of ATMIST significantly improves communication with medical practitioners, ambulance crews and emergency departments.
When providing a clinical patient handover to an NHS Ambulance Crew it is advisable to apply the ATMIST approach. Many NHS ambulance services and hospitals now promote the use of ATMIST in this situation, as it facilities a rapid, accurate handover.
Team handover and crew debriefing:
The aim of an handover is to achieve the efficient communication of high quality clinical information at any time when the responsibility for a patient care is transferred. The quality of this handover can have an impact on patient care. There is significant variation in the quality of handovers from prehospital to emergency department medical teams and the handovers following OHCA is particularly challenging as a lot of information needs to be communicated to the hospital team when resuscitation may be ongoing.
- What's the point?: “Handover of care is one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients.” Professor Sir John Lilleyman, Medical Director, National Patient Safety Agency, UK
- What's the problem? “HealthCare professionals sometimes try to give the verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment. Unless both teams are able to concentrate on the handover of a sick patient, valuable information will be lost.” Junior Doctors Committee, British Medical Association
- Barriers to effective handover: Barriers to an effective handover include lack of structure, duration of handover, gaining the attention of receiving medical staff, lack of training, noise and other distractions, and difficulty recalling important multiple facts and complex information.
- Effective handover: The use of a handover template to facilitate the rapid transfer of information during resuscitation (e.g. ATMIST – see below).
Source: www.resus.org.uk/resuscitation-guidelines/prehospital-resuscitation/#handover
To use a handover template effectively keep the information under each of the titles short, clear and concise. To reinforce the structure of each handover section, announce the titles before the section information. Consider using a written template and practice your handover prior to hospital arrival.
Speak loudly and clearly using the template heading: pauses will enable important points to be understood and assimilated. Be concise and try and limit the handover. Adjuncts to handover such as pictures from the scene can be extremely useful. If you have taken them, show them to the hospital team leader.
References:
Resuscitation Council (UK) 2015 Guidelines, 4th Edition Jan 2016 ISBN 978-1-903812-31-0
https://www.resus.org.uk/resuscitation-guidelines/prehospital-resuscitation/
Dr Davy Green, Handovers
http://gcs3.co.uk/ed/ni-trauma/basics-ni/
