Multi-professional patterns and methods of communication during patient handoffs
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.
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