Ambulance to Emergency Department Handover Project

The 'NSW Ambulance-to-ED handover project ( pdf - 2.4 MB)' was funded by the Ministerial Taskforce for Emergency Care to develop a handover protocol that ensured the smooth transfer of pre-hospital care into the acute setting.

The outputs of the project align with the Standard Key Principles and are now being planned for broader implementation.

Development of a handover protocol

The research was conducted by the Centre for Health Communication, UTS, using 'video-reflexive ethnography'. This methodology enables clinicians to evaluate their own practice by examining video recorded of them and then reflexively comment on it. This ensures clinicians shape the development of practice change.

Throughout development of the protocol it was ensured that it aligned with all elements of the Standard Key Principles for Clinical handover. The protocol was implemented and evaluated with the assistance of the Ambulance Service of NSW and the Emergency Departments of Royal Prince Alfred and John Hunter Hospitals. The study showed implementation of the protocol resulted in improved structure and amount of information handed over, improved comprehension by ED staff, reduced length of time taken for handover and improved eye contact.

The IMIST-AMBO handover protocol

The IMIST-AMBO protocol encompasses standardisation of the information to be handed over and the processes that surround handover.

Acronym for information standardisation:

I – Identification
M – Mechanism/Medical complaint
I – Injuries/Information relative to the complaint
S – Signs
T – Treatment and Trends
A – Allergies
M – Medication
B – Background history
O – Other information

Download the IMIST-AMBO Handover protocol poster ( pdf - 168 KB)

IMIST-AMBO aligns with the ISBAR acronym ( pdf - 153 KB) for handover.

Standardisation of the handover process

An example of handover process standardisation includes:

Ambulance paramedics asked to:

Review handover details pre-arrival
Maintain a 20-30 second period where the patient remains on the stretcher and deliver IMIST information uninterrupted
Encourage questions on completion of IMIST and again at the end of AMBO
Treating paramedic to remain with the patient
Record half hourly observations whilst the [patient remains under paramedic care
If the patient deteriorates, increase observation frequency to fifteen minutely (yellow zone)
Changes in the patient condition must be reported to the triage nurse immediately

ED clinicians asked to:

Ensure the handover remains interruption free
Ask questions during the two provided opportunities, between IMIST and AMBO and upon completion of IMIST-AMBO
'Hands off, Eyes on' - A 20-30 second period is provided for where the patient stays on the Ambulance trolley until the IMIST component is handed
Identify trauma team leaders

Implementation support tools

Poster for display at triage ( pdf - 168 KB)
IMIST-AMBO formatted triage sheet ( pdf - 446 KB)
DVD on the use of IMIST-AMBO in the Emergency Department (above) download an MP4 version (25 MB)