Characterization of a handoff documentation tool through usage log data.

Handoffs are a critical component of coordinated patient care; however, poor handoffs have been associated with near misses and adverse events. To address this, national agencies have recommended standardizing handoffs, for example through the use of handoff documentation tools. Recent research suggests that handoff tools, typically designed for physicians, are often used by non-physician providers as information sources. In this study, we investigated patterns of edits of an electronic handoff tool in a large teaching hospital through examination of its usage log data. Qualitative interviews with clinicians were used to triangulate log data findings. The analysis showed that despite its primary focus on facilitating transitions of care, information in the handoff documentation tool was updated throughout the day. Interviews with residents confirmed that they purposefully updated information to make it available for other members of their patient care teams. This further reiterates the view of electronic handoff tools as facilitators of team communication and coordination. However, the study also showed considerable variability in the frequency of updates between different units and across different patients. Further research is required to understand what factors drive such diversity in the use of electronic handoff tool and whether this diversity can be used to make inferences about patients' conditions.