Nicholas A Rattray1,2,3, Mindy E Flanagan4, Laura G Militello5, Paul Barach6, Zamal Franks4, Patricia Ebright7, Shakaib U Rehman8, Howard S Gordon9, Richard M Frankel4,10,11. 1. VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA. nrattray@iupui.edu. 2. Department of Anthropology, Indiana University-Purdue University Indianapolis, Indianapolis, USA. nrattray@iupui.edu. 3. Regenstrief Institute, Inc., Indianapolis, IN, USA. nrattray@iupui.edu. 4. VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA. 5. Applied Decision Science, LLC, Dayton, USA. 6. Jefferson College of Population Health, Wayne State University School of Medicine, Detroit, USA. 7. Indiana University School of Nursing, Indianapolis, USA. 8. Phoenix VA Healthcare Systems, University of Arizona College of Medicine-Phoenix, Phoenix, USA. 9. Jesse Brown VAMC, VA HSR&D Center of Innovation for Complex Chronic Healthcare, University of Illinois at Chicago, Chicago, USA. 10. Regenstrief Institute, Inc., Indianapolis, IN, USA. 11. Indiana University School of Medicine, Indianapolis, USA.
Abstract
BACKGROUND: Poor communication during end-of-shift transfers of care (handoffs) is associated with safety risks and patient harm. Despite the common perception that handoffs are largely a one-way transfer of information, researchers have documented that they are complex interactions, guided by implicit social norms and mental frameworks. OBJECTIVES: We investigated communication strategies that resident physicians report deploying to tailor information during face-to-face handoffs that are often based on their implicit inferences about the perceived information needs and potential harm to patients. METHODS/PARTICIPANTS: We interviewed 35 residents in Medicine and Surgery wards at three VA Medical Centers (VAMCs). MAIN MEASURES: We conducted qualitative interviews using audio-recorded semi-structured cognitive task interviews. KEY RESULTS: The effectiveness of handoff communication depends upon three factors: receiver characteristics, type of shift, and patient's condition and perceived acuity. Receiver characteristics, including subjective perceptions about an incoming resident's training or ability levels and their assumed preferences for information (e.g., detailed/comprehensive vs. minimal/"big picture"), influenced content shared during handoffs. Residents handing off to the night team provided more information about patients' medical histories and care plans than residents handing off to the day team, and higher patient acuity merited more detailed information and the medical service(s) involved dictated the types of information conveyed. CONCLUSIONS: We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as "recipient design." Interventions should focus on raising awareness of times when information is omitted, customized, or expanded based on implicit judgments, the emerging threats such judgments pose to patient care and quality, and the competencies needed to be more explicit in handoff interactions.
BACKGROUND: Poor communication during end-of-shift transfers of care (handoffs) is associated with safety risks and patient harm. Despite the common perception that handoffs are largely a one-way transfer of information, researchers have documented that they are complex interactions, guided by implicit social norms and mental frameworks. OBJECTIVES: We investigated communication strategies that resident physicians report deploying to tailor information during face-to-face handoffs that are often based on their implicit inferences about the perceived information needs and potential harm to patients. METHODS/PARTICIPANTS: We interviewed 35 residents in Medicine and Surgery wards at three VA Medical Centers (VAMCs). MAIN MEASURES: We conducted qualitative interviews using audio-recorded semi-structured cognitive task interviews. KEY RESULTS: The effectiveness of handoff communication depends upon three factors: receiver characteristics, type of shift, and patient's condition and perceived acuity. Receiver characteristics, including subjective perceptions about an incoming resident's training or ability levels and their assumed preferences for information (e.g., detailed/comprehensive vs. minimal/"big picture"), influenced content shared during handoffs. Residents handing off to the night team provided more information about patients' medical histories and care plans than residents handing off to the day team, and higher patient acuity merited more detailed information and the medical service(s) involved dictated the types of information conveyed. CONCLUSIONS: We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as "recipient design." Interventions should focus on raising awareness of times when information is omitted, customized, or expanded based on implicit judgments, the emerging threats such judgments pose to patient care and quality, and the competencies needed to be more explicit in handoff interactions.
Authors: Reed G Williams; Ross Silverman; Cathy Schwind; John B Fortune; John Sutyak; Karen D Horvath; Erik G Van Eaton; Georges Azzie; John R Potts; Margaret Boehler; Gary L Dunnington Journal: Ann Surg Date: 2007-02 Impact factor: 12.969
Authors: Sunil Kripalani; Frank LeFevre; Christopher O Phillips; Mark V Williams; Preetha Basaviah; David W Baker Journal: JAMA Date: 2007-02-28 Impact factor: 56.272
Authors: Laura G Militello; Nicholas A Rattray; Mindy E Flanagan; Zamal Franks; Shakaib Rehman; Howard S Gordon; Paul Barach; Richard M Frankel Journal: Jt Comm J Qual Patient Saf Date: 2018-05-02
Authors: Alicia A Bergman; Mindy E Flanagan; Patricia R Ebright; Colleen M O'Brien; Richard M Frankel Journal: BMJ Qual Saf Date: 2015-07-28 Impact factor: 7.035