Bridging gaps in handoffs: A continuity based approach

Center for Cognitive Informatics and Decision Making, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX 77030, USA.
Journal of Biomedical Informatics (Impact Factor: 2.48). 11/2011; 45(2):240-54. DOI: 10.1016/j.jbi.2011.10.011
Source: PubMed

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.

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Available from: Thomas Kannampallil, Aug 24, 2015
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    • "Canadian study, it was shown that 19 % of patients suffered adverse events after discharge from hospital, 70 % of which were either preventable or ameliorable (Forster et al. 2003). Lack of information and communication seems to be a major reason why gaps occur, and better information to patients has been proposed as a way of improving safety (Abraham et al. 2012; Tandjung et al. 2011). "
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    ABSTRACT: Gaps in the continuity of care may appear as losses of information or momentum or as interruptions in the delivery of care. To systematically improve patient safety, we need to know more about how gaps in the continuity of health care are identified and mitigated. This study seeks to describe healthcare professionals’ understanding of how they anticipate, detect and handle gaps in cancer care. Ten focus-group interviews and two individual interviews were conducted with a total of 34 cancer-care professionals (physicians, nurses, managers and administrators) from three counties in mid-Sweden. Various specialties in cancer care were covered: primary care, in-hospital care, palliative care, advanced home care, and children’s care. Interviews were analyzed inductively using qualitative content analysis. The results show that patient safety in cancer care is dependent on a resilient organization that is capable of anticipation, monitoring, adapting and learning at all levels of care. The professionals anticipated gaps in situations where contacts between healthcare providers were limited and when they were faced by time or resource constraints. The extent to which gaps could be managed by professionals at the sharp end was largely determined by their ability to adapt to complex and unexpected situations in their daily work. The management of gaps was perceived differently by managers and clinicians, however. The study also indicates that the continuity of care could be improved by patients’ participation in decisions about treatments and care plans, and by a mutual responsibility for the transfer of information and knowledge across professional boundaries. These results are discussed from a resilience engineering perspective, and they emphasize the management’s responsibility to address gaps identified in the system. Designing resilient healthcare organizations enables professionals at the sharp end to prevent human error or mitigate its consequences.
    Cognition Technology & Work 10/2014; 17(1). DOI:10.1007/s10111-014-0311-1 · 1.00 Impact Factor
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    • "As care becomes more and more complex, communication and organizational aspects become increasingly important. Improved information to patients and shared decision making has been proposed as a way of improving safety [1] [4]. When patients participate more actively in the process of care, it is claimed that the healthcare system will be characterized by services of higher quality, better outcomes, lower costs, fewer "
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    ABSTRACT: Web-based self-management support systems SMSS, can successfully assist a wide range of patients with information and self-management support. O or as a stand-alone service, are e-messages. This study describes how one component of a multi component SMSS, an e-message service, in which patients with breast cancer could direct questions to nurses, physicians or social workers at the hospital where they were being treated, had an influence on safety and continuity of care. Ninety-one dialogues consisting of 284 messages were analysed. The communications between patients and the healthcare team revealed that the e-messages service served as a means for quality assurance of information, for double-checking and for coordination of care. We give examples of how an e-mail service may improve patients' knowledge in a process of taking control over their own care - increasingly important in a time of growing complexity and specialization in healthcare. It remains to be tested whether an e-message service can improve continuity of care and prevent or mitigate medical mishaps.
    Studies in health technology and informatics 01/2014; 201:328-34.
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    • "Handoff communication framework that evolves between the sender (resident/intern) and receiver (attending): the framework shows the range of CEs that arise during the process of handoff communication. The figure has been adapted from Abraham et al[40] with permission. "
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    ABSTRACT: Handoffs vary in their structure and content, raising concerns regarding standardization. We conducted a comparative evaluation of the nature and patterns of communication on 2 functionally similar but conceptually different handoff tools: Subjective, Objective, Assessment and Plan, based on a patient problem-based format, and Handoff Intervention Tool (HAND-IT), based on a body system-based format. A nonrandomized pre-post prospective intervention study supported by audio recordings and observations of 82 resident handoffs was conducted in a medical intensive care unit. Qualitative analysis was complemented with exploratory sequential pattern analysis techniques to capture the characteristics and types of communication events (CEs) and breakdowns. Use of HAND-IT led to fewer communication breakdowns (F1,80 = 45.66: P < .0001), greater number of CEs (t40 = 4.56; P < .001), with more ideal CEs than Subjective, Objective, Assessment and Plan (t40 = 9.27; P < .001). In addition, the use of HAND-IT was characterized by more request-response CE transitions. The HAND-IT's body system-based structure afforded physicians the ability to better organize and comprehend patient information and led to an interactive and streamlined communication, with limited external input. Our results also emphasize the importance of information organization using a medical knowledge hierarchical format for fostering effective communication.
    Journal of critical care 11/2013; 29(2). DOI:10.1016/j.jcrc.2013.11.014 · 2.19 Impact Factor
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