Bridging gaps in handoffs: A continuity of care based approach

Joanna Abraham, Thomas G. Kannampallil, Vimla Patel

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)240-254
Number of pages15
JournalJournal of Biomedical Informatics
Volume45
Issue number2
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Continuity of Patient Care
Communication
Workflow
Audio recordings
Medical Errors
Intensive care units
Information Management
Information Dissemination
Critical Care
Health Personnel
Artifacts
Information management
Intensive Care Units
Decision Making
Patient Care
Decision making
Trajectories
Interviews
Research

Keywords

  • Communication
  • Critical care
  • Handoffs
  • Handovers
  • Information breakdowns
  • Information transfer
  • Resident sign-out

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics

Cite this

Bridging gaps in handoffs : A continuity of care based approach. / Abraham, Joanna; Kannampallil, Thomas G.; Patel, Vimla.

In: Journal of Biomedical Informatics, Vol. 45, No. 2, 01.01.2012, p. 240-254.

Research output: Contribution to journalArticle

Abraham, Joanna ; Kannampallil, Thomas G. ; Patel, Vimla. / Bridging gaps in handoffs : A continuity of care based approach. In: Journal of Biomedical Informatics. 2012 ; Vol. 45, No. 2. pp. 240-254.
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