BRIDGE THAT GAP!
So one of the most important things about turning over patient care to the following provider is the communication of the patient’s condition and treatment. Poor communication causes delays and potentially sets the future provider up for failure. That failure translates directly to a poor patient outcome. In order to ensure success for future providers and a better outcome for the patient, we need to organize the handoff communication. Utilizing a tool here can help with that success.
MIST, not just a computer game.
So what does MIST stand for exactly?
Mechanism of injury or Medical complaint. Being detailed here can help providers formulate a treatment plan. If you were the initial responder, the following provider didn’t get to see the scene the same way you did. Parts of your description will be forgotten, so more details means that even that 50% of your report that gets passed along will be detailed as well. “Pinned by the dash with windshield spidering at the patient’s head” can result in a FAST exam and head/neck x-rays and CT. “Front end vehicle damage” describing the same car means potentially only head/neck x-rays.
Injuries or Inspections. What did you find on your exam? This helps the following provider follow up on treatment you’ve already done. “GSW to right chest” and the following provider may be more aggressive with listening to lung sounds. Time of the injury will also be significant for treatment plans. Onset time for stroke symptoms helps an MD decide whether or not the patient will receive TPA. If reporting injuries, you can list as ABC then head to toe or simply head to toe.
Signs, Vital. This gives a following provider a snapshot of how severe the patient’s condition is. Typically with medical patients the last set of vital signs and anything significantly abnormal is preferred. Initial vital signs help provide trending. With trauma patients, the lowest BP, highest HR, RR, lowest SpO2, BGL and lowest GCS. While these may not come from the same set of vital signs, it gives the following provider a snapshot of the sickest of each vital sign.
Treatment: What treatment has been done? Each treatment potentially needs follow up reevaluation. IV access with fluid volume given, splinting with pulse/motor status before and after splinting, medications given, any cardiac rhythm changes or electrical treatment.
SAMPLE: Sometimes highlights from the SAMPLE history can be helpful. A quick list of allergies might help prevent a following provider from giving something that could be detrimental to a patient. A quick list of medications or pertinent highlights can help frame the situation that the patient may have a beta blocker in the face of traumatic hemorrhage. Finally, pertinent medical history on the patient can help a provider search for more clues to the patient’s condition or monitor something that may be imminent. Had a stroke before? Residual deficits may mean that the neuro findings on the next check aren’t as severe as if they are acute onset.
Handoff communication is extremely relevant. So many times providers will simplify as much as possible to the point where the patient’s experience is summed up in a single sentence. “Diabetic, woke them up with D50,” doesn’t quite give the backstory on how the patient has been battling with this problem recently and that their blood pressure was hypertensive. While extensive details may be best left for documentation/charting, effective and proper communication helps the following providers continue care fluidly for the patient.