Graph 1: EMS & ED Perceptions of Handoff Quality
Medicine
Perceptual Discordance Between EMS and ED Providers During Pediatric Handoffs: Insights From a Paired Survey Study
Medicine
Perceptual Discordance Between EMS and ED Providers During Pediatric Handoffs: Insights From a Paired Survey Study
Jack Crowley, Class of 2028, completed this project as part of MED 813: Scholarly Reflection and Concentration Capstone under the mentorship of Dr. Richard Feinn, professor of medical sciences and Dr. Sharon R. Smith, professor of pediatrics.
Overview
This project evaluated the quality of communication during pediatric EMS-to-ED handoffs through paired surveys to EMS and ED clinicians. It aimed to identify discrepancies between EMS and ED provider perceptions of handoff clarity, accuracy and completeness, and determine commonly perceived barriers to communication.
Researcher
Jack Crowley, Class of 2028
MD Program
Frank H. Netter MD School of Medicine
Perceptual Discordance Between EMS and ED Providers During Pediatric Handoffs: Insights From a Paired Survey Study
Background
- Communication failures are a leading cause of up to 80% of preventable medical errors
- The EMS-to-ED handoff is particularly vulnerable in pediatrics due to unique physiology, patient communication challenges, and caregiver involvement
- Prior research is one sided or uses objective measures only, leaving gaps in understanding
Objectives
- Evaluate the quality of pediatric EMS-to-ED handoff communication
- Assess perceptual discordance between EMS and ED providers regarding handoff quality
- Identify communication barriers and handoff improvement opportunities
Methods
- Study Design: Prospective observational study using paired, encounter-level surveys, developed based on literature and pilot-tested for clarity
- Participants: EMS and ED staff involved in pediatric patient handoffs
- Data Collection: Matched surveys assessed perceptions of handoff quality, clarity, accuracy, and completeness
- Analysis: Paired quantitative responses were compared to assess perceptual discordance; qualitative responses were thematically analyzed
Results
- To date, 457 surveys have been completed, 383 of which have been successfully paired by patient encounter
- Significant perceptual differences were identified between groups:
- EMS providers reported lower perceived respect during handoffs than ED clinicians (p = 0.007) while simultaneously expressing greater confidence in accuracy (p = 0.046).
- In contrast, ED clinicians rated EMS reports as less clear than EMS providers did (p = 0.006) and were more likely to request repeated information during handoff (p = 0.007).
- Overall handoff quality was also rated lower by ED clinicians compared with EMS providers (p = 0.044).
- Qualitative analysis of short-answer responses identified several recurring themes including suboptimal handoff environments, insufficient information, issues related to respect, lack of ED preparedness, desire for a written handoff or documentation, scope of practice, and concerns related to patient privacy during handoff.
Results
Graph 2: Differences in Handoff Barriers Between EMS & ED
Graph 3: Overall Handoff Quality
Conclusions
- Significant discordance exists between EMS and ED clinicians during pediatric patient handoffs.
- Statistical and thematic analysis revealed issues including respect, clarity, accuracy, confidence, handoff environment, facility preparedness, understanding scope of practice, desire for written report and patient privacy.
- These findings highlight the need for standardized handoff frameworks that foster shared expectations and stronger EMS–ED collaboration.
- Data collection is ongoing and planned analyses to further characterize factors influencing EMS–ED handoff quality.
Professional Application
"This project has significantly prepared me for a career in emergency medicine by strengthening both my clinical perspective and my ability to conduct meaningful, practice-changing research. Through studying EMS-to-ED handoffs, I developed a deeper understanding of the critical role communication plays in high-acuity, time-sensitive environments, reinforcing skills that are directly applicable to my future work in the emergency department. The project also provided hands-on experience in research design, multi-site coordination, IRB processes, and data management, all of which are essential for contributing to quality improvement and systems-based practice in medicine. Working with paired datasets and advanced statistical methods improved my ability to critically analyze clinical data and interpret findings in a way that can inform real-world practice. Additionally, presenting this work at regional and national conferences strengthened my ability to communicate complex ideas clearly and engage with interdisciplinary teams. Overall, this project has reinforced my interest in emergency medicine, particularly in improving prehospital and ED transitions of care, and has equipped me with the skills to continue pursuing research and leadership roles throughout my career." - Jack Crowley, Class of 2028
Mentors
Sharon R. Smith, MD
Connecticut Children's Hosptial
For Further Discussion
This serves as an overview of the project and does not include the complete work. To further discuss this project, please email Jack Crowley.
Course Overview
In MED 813: Scholarly Reflection & Concentration Capstone will personalize their curriculum and prepare for scholarly endeavors during residency and future practice. Students design and execute a capstone project in an area about which they are passionate. Learners use narrative medicine and their experience of being mentored to develop personally and professionally. They gain both conceptual understanding and practical skills in research methods, epidemiology, medical informatics, biostatistics, evaluating information sources, and critical appraisal of medical literature. Information presented in the SRCC course is integrated whenever possible with material in the Foundations of Medicine and the Clinical Arts and Sciences courses, to enable learners to apply biostatistics, epidemiology and medical informatics to community and public health, medical literature interpretation and clinical decision-making.
Explore Our Areas of Interest
We've sorted each of our undergraduate, graduate and doctoral programs into unique Areas of Interest. Explore these categories to discover which programs and delivery methods best align with your educational and career goals.