TY - JOUR
T1 - Bridging gaps in handoffs
T2 - A continuity of care based approach
AU - Abraham, Joanna
AU - Kannampallil, Thomas G.
AU - Patel, Vimla L.
N1 - Funding Information:
This research was supported in part by a training fellowship from the Keck Center AHRQ Training Program in Patient Safety and Quality of the Gulf Coast Consortia (AHRQ Grant No. 1 T32 HS017586-02 to Joanna Abraham) and from the James S. McDonnell Foundation (Grant 220020152 to Vimla L. Patel). We would like to thank our clinical collaborators Bela Patel and Khalid F. Almoosa for facilitating and assisting with this study. We are also extremely thankful to the two anonymous reviewers for their detailed and valuable comments that greatly improved the quality of our paper.
PY - 2012/4
Y1 - 2012/4
N2 - Handoff among healthcare providers has been recognized as a major source of medical errors. Most prior research has often focused on the communication aspects of handoff, with limited emphasis on the overall handoff process, especially from a clinician workflow perspective. Such a workflow perspective that is based on the continuity of care model provides a framework required to identify and support an interconnected trajectory of care events affecting handoff communication. To this end, we propose a new methodology, referred to as the clinician-centered approach that allows us to investigate and represent the entire clinician workflow prior to, during and, after handoff communication. This representation of clinician activities supports a comprehensive analysis of the interdependencies in the handoff process across the care continuum, as opposed to a single discrete, information sharing activity. The clinician-centered approach is supported by multifaceted methods for data collection such as observations, shadowing of clinicians, audio recording of handoff communication, semi-structured interviews and artifact identification and collection. The analysis followed a two-stage mixed inductive-deductive method. The iterative development of clinician-centered approach was realized using a multi-faceted study conducted in the Medical Intensive Care Unit (MICU) of an academic hospital. Using the clinician-centered approach, we (a) identify the nature, inherent characteristics and the interdependencies between three phases of the handoff process and (b) develop a descriptive framework of handoff communication in critical care that captures the non-linear, recursive and interactive nature of collaboration and decision-making. The results reported in this paper serve as a " proof of concept" of our approach, emphasizing the importance of capturing a coordinated and uninterrupted succession of clinician information management and transfer activities in relation to patient care events.
AB - Handoff among healthcare providers has been recognized as a major source of medical errors. Most prior research has often focused on the communication aspects of handoff, with limited emphasis on the overall handoff process, especially from a clinician workflow perspective. Such a workflow perspective that is based on the continuity of care model provides a framework required to identify and support an interconnected trajectory of care events affecting handoff communication. To this end, we propose a new methodology, referred to as the clinician-centered approach that allows us to investigate and represent the entire clinician workflow prior to, during and, after handoff communication. This representation of clinician activities supports a comprehensive analysis of the interdependencies in the handoff process across the care continuum, as opposed to a single discrete, information sharing activity. The clinician-centered approach is supported by multifaceted methods for data collection such as observations, shadowing of clinicians, audio recording of handoff communication, semi-structured interviews and artifact identification and collection. The analysis followed a two-stage mixed inductive-deductive method. The iterative development of clinician-centered approach was realized using a multi-faceted study conducted in the Medical Intensive Care Unit (MICU) of an academic hospital. Using the clinician-centered approach, we (a) identify the nature, inherent characteristics and the interdependencies between three phases of the handoff process and (b) develop a descriptive framework of handoff communication in critical care that captures the non-linear, recursive and interactive nature of collaboration and decision-making. The results reported in this paper serve as a " proof of concept" of our approach, emphasizing the importance of capturing a coordinated and uninterrupted succession of clinician information management and transfer activities in relation to patient care events.
KW - Communication
KW - Critical care
KW - Handoffs
KW - Handovers
KW - Information breakdowns
KW - Information transfer
KW - Resident sign-out
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U2 - 10.1016/j.jbi.2011.10.011
DO - 10.1016/j.jbi.2011.10.011
M3 - Article
C2 - 22094355
AN - SCOPUS:84858289299
SN - 1532-0464
VL - 45
SP - 240
EP - 254
JO - Journal of Biomedical Informatics
JF - Journal of Biomedical Informatics
IS - 2
ER -