202 Handover of road traffic injured patients in emergency departments in Nepal

Background Road traffic crashes and injuries are increasing in Nepal, and post-crash response services are early in their development. Ambulance services are offered by multiple providers and most of them lack trained emergency medical technicians. Once an ambulance arrives at the hospital, trauma victims are transported to the emergency department. Since emergency departments are busy with dynamic environments, the handover process between prehospital providers and emergency department staff can be challenging. The quality of the handover can have a significant impact on patient outcomes. Objective To understand the current handover practices of road traffic injured (RTI) patients in the emergency departments of tertiary hospitals in Nepal to inform progress to standardising patient care. Methods In order to improve collaboration and communication between hospitals that may manage mass casualties following major incidents and earthquakes, 25 hospitals were identified throughout the country as tertiary centres for trauma care. We invited staff in these hospitals to participate in a survey. An online questionnaire using Microsoft Forms was used to capture information about how they manage the handover of RTI patients between prehospital and in-hospital staff in the emergency department. The survey was circulated through email to the in-charge of the emergency department or their designated deputy. Quantitative data were analysed using descriptive statistics while qualitative data were analysed thematically using NVivo. Results The handover process for RTI patients varied between the hospitals that responded to the survey. No standardised handover process was found. Some of the hospitals either received pre-information but not in any standard way or did not receive any information about the critically injured RTI patients before they arrived. Therefore, the staff at the emergency department in some of the hospitals were not sufficiently prepared. Conclusions The survey findings suggest that the handover of RTI patients in emergency departments may benefit from standardisation. Future work will include interviews with staff and ethnographic observation of the handover of RTI patients in emergency departments to inform the development of a handover protocol and training guide.