The Effects of an ISOBAR-Structured Patient Handover Conversation Between Rescue Services and Emergency Department Staff: The COPTER Trial.

Abstract

Objectives: Communication errors are the main cause of adverse events in emergency medicine, underscoring the importance of patient handover conversations. This study aims to assess the impact of implementing the ISOBAR handover protocol for patient transfer between emergency medical services and emergency department (ED) personnel.

Methods: We conducted a single-center implementation trial to evaluate the ISOBAR handover protocol efficacy in a German university hospital ED. We observed and analyzed 651 handover conversations involving adult patients, comparing those using the ISOBAR protocol to those following standard procedure without the protocol. Direct observation of handover processes was employed during alternating interventional periods across 6 trial phases. Primary outcome measure was the "Key Information Transfer Efficiency" score (KITE), a higher score indicating a more efficient patient handover conversation. Secondary outcome measure was the retention of key information by ED personnel, indicating successfully conveyed information.

Results: The KITE score was significantly higher in the ISOBAR group (difference 0.12, 95% CI 0.02-0.22), showing a notable increase from baseline without ISOBAR to the final trial phase using ISOBAR (difference 0.16, 95% CI 0.02-0.34). Key information retention increased significantly: +18% for physicians (95% CI 9-28) and +19% (95% CI 10-28) for nurses. The number of questions asked after handover decreased by 29% (95% CI 5.81-41.46). The adherence to ISOBAR had no notable effect on outcome measures.

Conclusion: The implementation of ISOBAR can enhance information transfer during handover. However, adherence to ISOBAR was not crucial, highlighting the importance of focusing on quality of communication during patient handover.