Multi-professional patterns and methods of communication during patient handoffs

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Abstract

Objective

Health information technology has been shown to influence the communication patterns of healthcare providers. The goal of this study was to learn more about how healthcare providers communicate and exchange patient clinical information during patient handoffs (transfers) between units in an acute care setting.

Methods

Convenience sampling was used to select five patient handoffs. Questionnaires were distributed to providers identified through observation and snowball sampling. Social network analysis methodology was used to develop sociograms of the emergent communication patterns and identify the role of individual providers in the handoff process based on the number of contacts with other providers and incoming and outgoing communication activity. Individual handoff network size ranged from 11 to 20 providers. Participants were asked to describe the method of communication they used to access or share clinical information with other providers, their preferred method of communication; their satisfaction with the available options; and their suggestions for how the process could be improved.

Results

The network patterns that emerged uncovered the overlapping use of synchronous and asynchronous communication methods (verbally via phone or in person; or written via paper charts and/or an electronic records). No particular professional group dominated or coordinated information flow; instead each handoff network exhibited unique communication patterns and information coordination by two or more influential providers from nursing, medicine, or pharmacy. Most (84%) participants preferred verbal communication. Overall satisfaction with the current communication process varied by unit: 82% of emergency department providers and 54% of the providers working in the admitting units stated they were satisfied or very satisfied. Recommendations for improvement included converting all units to the electronic health record, electronic handoff communication modules and asynchronous multi-professional communication logs.

Conclusions

The results of this exploratory study provide a foundation for future research examining how network structure and communication principles can be used to design health information technology that compliments the non-linear information gathering and dissemination behaviors of providers from multiple professions.

Introduction

For over 20 years healthcare professionals have known that the quality of communication among providers influences patient care [1]. One particularly high-risk process in which patient outcomes depend critically on effective communication among healthcare providers is the patient handoff [2], [3], [4], [5], [6]. Patient handoff, where the responsibility for patient care is transferred from one provider to another and the initial provider physically leaves the scene, has been identified as a communication-dependent process that is particularly vulnerable to errors of omission [7]. The healthcare providers assuming care of the patient require up-to-date patient information in order to make informed decisions and provide seamless care; which, in turn, requires the free flow of information between all providers involved with the handoff [7]. In this paper, we describe the results of a descriptive, exploratory research study aimed at examining the patterns and methods (verbal, paper or electronic record) of communication used by healthcare providers from multiple professions to exchange clinical information during a patient handoff.

Section snippets

Background

As the healthcare environment has grown more complex, the sharing of patient clinical information among multiple providers has become more problematic. Today's hospital environment is characterized by the provision of complex care through short encounters with multiple providers, a situation fraught with opportunities for communication breakdowns that can lead to increased medical errors [8], [9], [10], [11], [12]. Reducing medical error in this disjointed environment has emerged as a crucial

Network analysis

Network analysis (NA) provides the means to study complex networks and is often categorized by the network of interest. One type of NA, organizational network analysis (ONA) examines the relationships between groups or organizations, including uncovering and examining patterns of behavior; the situations under which these behavior patterns arise; and the consequences of specific patterns on group behavior. ONA has been used to examine collaboration and information sharing between public health

Clinical information documentation and communication options

A priori identification of the methods of information exchange and communication available to providers in this facility was necessary for designing a survey. Fig. 1 provides an overview of the hybrid documentation system and clinical information documentation options available to providers. The ED uses a paper documentation system. On admission the paper record is scanned into an image-based electronic record. Unit based providers must access multiple sources of clinical information; two paper

Discussion

This exploratory study examined multi-professional communication networks in order to provide accurate portrayals of real-life patient handoff situations and to describe what currently exists. Consistent with earlier findings, the providers in this study used non-linear strategies, such as incorporating multiple methods of communication to multiple providers simultaneously, to transfer or assume care of the patient [79]. This process has been identified as “channel switching” – using multiple

Acknowledgements

We would like to express our gratitude to the Director of Nursing Research, unit managers, and professional group representatives at the research site for their assistance and support and the nurses, physicians, social workers, and pharmacists who took the time to participate. Partial funding for this study was received from Sigma Theta Tau – Delta Theta Chapter.

References (92)

  • C. Cott

    “We decide, you carry it out”: a social network analysis of multidisciplinary long-term care teams

    Social Science & Medicine

    (1997)
  • A. Kushniruk et al.

    Cognitive and usability engineering methods for the evaluation of clinical information systems

    Journal of Biomedical Informatics

    (2004)
  • J. Horsky et al.

    Comprehensive analysis of a medication dosing error related to CPOE

    Journal of the American Medical Informatics Association

    (2005)
  • W. Stead et al.

    Achievable steps toward building a national health information infrastructure in the United States

    Journal of the American Medical Informatics Association

    (2005)
  • K. McCauley et al.

    Changing the work environment in ICUs to achieve patient-focused care

    Chest

    (2006)
  • K.R. Simpson et al.

    Nurse-Physician communication during labor and birth: implications for patient safety

    Journal of Obstetric, Gynecologic, and Neonatal Nursing

    (2006)
  • J. Merrill et al.

    Description of a method to support public health information management: organizational network analysis

    Journal of Biomedical Informatics

    (2007)
  • M. Gold et al.

    Understanding a collaborative effort to reduce racial and ethnic disparities in health care

    Social Science & Medicine

    (2008)
  • J. Horsky et al.

    Commentary: to err is not entirely human: complex technology and user cognition

    Journal of Biomedical Informatics

    (2005)
  • N. Abramson et al.

    Adverse occurrences in intensive care units

    Journal of the American Medical Association

    (1980)
  • R.I. Cook et al.

    Gaps in the continuity of care and progress on patient safety

    British Medical Journal

    (2000)
  • JCICP, Strategies to Improve Hand-Off Communication: Implementing a Process to Resolve Questions, Joint commission...
  • D.J. Solet et al.

    Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs

    Academic Medicine

    (2005)
  • A. Vidyarthi, A Fumbled Handoff: Missed communication between teams, Cases and Commentaries: Hospital Medicine 2004...
  • M.A. Friesen et al.

    Handoffs: Implications for Nurses. Patient Safety and Quality: An Evidence-Based Handbook for Nurses

    (2008)
  • M.M. Dierks, C. Christian, E. Roth, T. Sheridan, The Patient Handoff as a Complex Task: Improving Performance through...
  • R.M. Wilson et al.

    The quality in Australian Health Care Study

    Medical Journal of Australia

    (1995)
  • L. Leape et al.

    The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II

    New England Journal of Medicine

    (1991)
  • K.M.P. Sutcliffe et al.

    Communication failures: an insidious contributor to medical mishaps

    Academic Medicine

    (2004)
  • L.A. Lenert et al.

    Federal patient safety initiatives panel summary

    Journal of the American Medical Informatics Association

    (2002)
  • N. Staggers

    Assessing recommendations from the IOM's quality chasm report

    Journal of the American Medical Informatics Association

    (2004)
  • Leapfrog, The Leapfrog Group for Patient Safety: Safety Objectives, 2005 [cited 2005, August 1], Available from:...
  • IOM

    Patient SAFETY: Achieving A New Standard for Care

    (2004)
  • B. Obama, President Barack Obama's Inaugural Address, 2009 [cited 2009, January 29], Available from:...
  • T.G. Thompson, D.J. Brailer, The Decade of Health Information Technology: Delivering Consumer-centric and...
  • JCAHO, Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future: The Joint...
  • JCAHO, Facts about 2006 National Patient Safety Goals, 2005 [cited 2005, August 1], Available from:...
  • R. Charette, Dying for data, IEEE Spectrum Online,...
  • L.K. McKnight et al.

    Perceived information needs and communication difficulties of inpatient physicians and nurses

    Journal of the American Medical Informatics Association

    (2002)
  • R. Koppel et al.

    Role of computerized physician order entry systems in facilitating medication errors

    Journal of American Medical Association

    (2005)
  • S.P. Clarke et al.

    More nursing, fewer deaths

    Quality & Safety in Health Care

    (2006)
  • M.E. Burkhardt et al.

    Changing patterns of patterns of change: the effects of change in technology on social network structure and power

    Administrative Science Quarterly

    (1990)
  • J.E. Richardson et al.

    The Effects of Hands Free Communication Devices on Clinical Communication: Balancing Communication Access Needs and User Control

    (2008)
  • B. Kaplan et al.

    Future directions in evaluation research: people, organizational, and social issues

    Methods of Information in Medicine

    (2004)
  • D.W. Bates et al.

    Reducing the frequency of errors in medicine using information technology

    Journal of the American Medical Informatics Association

    (2001)
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