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Development of a Shifting and Receiving Performa for ICU Patients: Reducing Communication Errors-A Delphi Study. Crit Care Nurs Q 2023; 46:185-191. [PMID: 36823745 DOI: 10.1097/cnq.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Critically ill patients are frequently transported between intensive care units (ICUs) and other sections of hospital, which may cause communication error. The aim of this study was to reduce errors while shifting and receiving of patients in and from the ICU. The present study was aimed to develop a Shifting and Receiving Performa for the patients admitted in the ICU of a tertiary care hospital. A multistage developmental study was conducted in ICUs. Eleven experts were selected by a purposive sampling technique, and the study was conducted in 4 phases. From the pool of items, a preliminary draft of the performa was prepared and the draft was given to experts to evaluate its content and face validity by conducting 2 Delphi rounds. The mean I-CVI of the shifting performa increased from 0.92 to 0.95, S-CVI/AVG exceeded from 0.88 to 0.96, and S-CVI/UA exceeded from 0.48 to 0.7 after Delphi round 2. In the case of the receiving performa, the mean I-CVI and S-CVI/AVG remained the same, that is, 0.98 in Delphi rounds 1 and 2. The mean S-CVI/UA also remained the same (ie, 0.9). The interrater reliability of the performa was found to be 0.95. Almost all the staff nurses found the performa to be beneficial, provided complete information, and reduced communication errors.
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Gu X, Itoh K. Inter‐shift handoff: Changes over a 6‐year interval. J Adv Nurs 2020; 76:3418-3428. [DOI: 10.1111/jan.14537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/29/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Xiuzhu Gu
- Department of Industrial Engineering and Economics School of Engineering Tokyo Institute of Technology Meguro‐ku Tokyo Japan
| | - Kenji Itoh
- Department of Industrial Engineering and Economics School of Engineering Tokyo Institute of Technology Meguro‐ku Tokyo Japan
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Perceptions and Experiences of Hospital Nurses During Transition to an Electronic Handover Informatics System. Comput Inform Nurs 2019; 37:591-598. [PMID: 31385815 DOI: 10.1097/cin.0000000000000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: "Perceptions of challenges and barriers related to the transition to a new handover informatics system," "Perceptions of benefits and strategies to the transition to a new handover informatics system," and "Suggestions for successful implementation of a new handover informatics system." Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system.
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Hou Y, Lu L, Lee P, Chang I. Positive Impacts of Electronic hand‐off systems designs on Nurses’ communication effectiveness. J Nurs Manag 2019; 27:1055-1063. [DOI: 10.1111/jonm.12774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/18/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ying‐Hui Hou
- Department of Health Industry Management Kainan University Taoyuan Taiwan
| | - Li‐Jung Lu
- Department of Nursing Yuan’s General Hospital Kaohsiung Taiwan
- Department of Information Management National Chung Cheng University Chia‐Yi Taiwan
| | - Pei‐Hsuan Lee
- Department of Community Health Ditmanson Medical Foundation Chia‐Yi Christian Hospital Chia‐Yi Taiwan
| | - I‐Chiu Chang
- Department of Information Management National Chung Cheng University Chia‐Yi Taiwan
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Ernst KM, McComb SA, Ley C. Nurse-to-nurse shift handoffs on medical-surgical units: A process within the flow of nursing care. J Clin Nurs 2018; 27:e1189-e1201. [PMID: 29314328 DOI: 10.1111/jocn.14254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To qualitatively investigate the medical-surgical nurse shift handoff as a process within the workflow of the exchanging nurses. Specifically, this study sought to identify the ideal handoff, ways the handoff deviated from ideal, and subsequent effect on nursing care. BACKGROUND The functions as well as information content of the handoff have been studied. However, typical studies look at the handoff as an isolated activity utilising nurse perceptions as the primary measure of quality. DESIGN Semi-structured focus groups were conducted to discuss nurses' perspectives on ideal handoffs, ways handoffs deviate from the ideal including frequent and significant deviations and the effects on subsequent care. METHODS Twenty-one medical-surgical nurses participated in one of five audio-taped focus group sessions. Three sessions were conducted at hospital A; two sessions at unaffiliated hospital B. The general inductive approach was used to analyse verbatim transcripts. Transcript segments relevant for answering the research questions were coded as ideal or not ideal. Conceptual themes were then developed. RESULT Two major themes were identified: teams/teamwork and constructing and communicating a shared understanding of the patients' conditions. The importance of nurse preparatory activities was revealed including the incoming nurses reading patients' health records and outgoing nurses rounding on patients. The impact of shared expectations was identified across the team, where teams include, in addition to the two nurses, the electronic health record, other hospital staff and patients/families with a bedside handoff. New potential nurse-centred process and outcome measures were proposed. CONCLUSIONS Evaluating handoffs by their effect on the nursing performance both during and after the handoff offers a new framework to objectively assess handoff effectiveness. RELEVANCE TO CLINICAL PRACTICE The handoff is a process which may significantly affect the incoming nurse's transition into and administration of nursing care.
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Thomson H, Tourangeau A, Jeffs L, Puts M. Factors affecting quality of nurse shift handover in the emergency department. J Adv Nurs 2017; 74:876-886. [DOI: 10.1111/jan.13499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Heather Thomson
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Ann Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
- St. Michael's Hospital; Toronto ON Canada
- Institute for Health Policy Management and Evaluation; University of Toronto; Toronto ON Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
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Alameddine M, Bauer JM, Richter M, Sousa-Poza A. The paradox of falling job satisfaction with rising job stickiness in the German nursing workforce between 1990 and 2013. HUMAN RESOURCES FOR HEALTH 2017; 15:55. [PMID: 28851392 PMCID: PMC5576280 DOI: 10.1186/s12960-017-0228-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 08/07/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND Literature reports a direct relation between nurses' job satisfaction and their job retention (stickiness). The proper planning and management of the nursing labor market necessitates the understanding of job satisfaction and retention trends. The objectives of the study are to identify trends in, and the interrelation between, the job satisfaction and job stickiness of German nurses in the 1990-2013 period using a flexible specification for job satisfaction that includes different time periods and to also identify the main determinants of nurse job stickiness in Germany and test whether these determinants have changed over the last two decades. METHODS The development of job stickiness in Germany is depicted by a subset of data from the German Socio-Economic Panel (1990-2013), with each survey respondent assigned a unique identifier used to calculate the year-to-year transition probability of remaining in the current position. The changing association between job satisfaction and job stickiness is measured using job satisfaction data and multivariate regressions assessing whether certain job stickiness determinants have changed over the study period. RESULTS Between 1990 and 2013, the job stickiness of German nurses increased from 83 to 91%, while their job satisfaction underwent a steady and gradual decline, dropping by 7.5%. We attribute this paradoxical result to the changing association between job satisfaction and job stickiness; that is, for a given level of job (dis)satisfaction, nurses show a higher stickiness rate in more recent years than in the past, which might be partially explained by the rise in part-time employment during this period. The main determinants of stickiness, whose importance has not changed in the past two decades, are wages, tenure, personal health, and household structure. CONCLUSIONS The paradoxical relation between job satisfaction and job stickiness in the German nursing context could be explained by historical downsizing trends in hospitals, an East-West German nurse compensation gap, and an increase in the proportion of nurses employed on a part-time basis. A clearer analysis of each of these trends is thus essential for the development of evidence-based policies that enhance the job satisfaction and efficiency of the German nursing workforce.
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Affiliation(s)
- Mohamad Alameddine
- College of Medicine, Directorate of Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box 505055, Dubai, United Arab Emirates
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jan Michael Bauer
- Department of Management, Society and Communication, Copenhagen Business School, Porcelænshaven 18, 2000 Frederiksberg, Denmark
| | - Martin Richter
- Institute for Healthcare & Public Management (530A), University of Hohenheim, Fruwirthstr. 48, 70599 Stuttgart, Germany
| | - Alfonso Sousa-Poza
- Institute for Healthcare & Public Management (530A), University of Hohenheim, Fruwirthstr. 48, 70599 Stuttgart, Germany
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Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients. Prehosp Disaster Med 2017; 32:541-547. [PMID: 28606198 DOI: 10.1017/s1049023x17006562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction Clinical handover by Emergency Medical Services (EMS) staff, as the first people who have contact with trauma patients, in the emergency department (ED), is very important. Therefore, effective communication to transfer clinical information about patients in a concise, rational, clear, and time-bound manner is essential. In Iran, the transfer of necessary information in clinical handover in EDs was carried out orally and without following standard instructions. This study aimed to audit the current clinical handover according to the Identify, Situation, Background, Assessment, and Recommendation (ISBAR) tool and survey the effect of training the ISBAR tool to Emergency Medicine Assistants (EMAs) and EMS staff on improvement of the clinical handover of patients to the ED. METHODS This is a clinical audit study in three phases in Imam Hossein Hospital (Tehran, Iran) during 2016. In the first phase, the clinical handover between EMS staff and EMAs for 178 trauma patients admitted to the ED using ISBAR was audited and information was recorded. In the second phase, the correct approach of clinical handover according to the ISBAR tool was taught to EMS staff and EMAs using pamphlets and lectures. In the third phase, again, the clinical handover between EMS staff and EMAs for 168 trauma patients admitted to the ED was audited using the ISBAR tool and information was recorded. At the end, clinical audit assessment indicators of handover were evaluated before and after training. RESULTS Clinical audit of the current situation in the ED showed that the clinical handover process does not follow standard ISBAR (0.0%). However, after training, 65.3% of clinical handover processes were performed in accordance with ISBAR. In the current study, there was an increase in all parameters of the ISBAR tool after training, most of which increased significantly compared to the first phase of the study (before the intervention). CONCLUSIONS Findings demonstrate that patient handover in the ED did not initially follow the ISBAR standard guideline. After providing education as pamphlets and lectures to EMS staff and EMAs, a high percentage of patient handovers were conducted in accordance with the ISBAR instructions. Fahim Yegane SA , Shahrami A , Hatamabadi HR , Hosseini-Zijoud SM . Clinical information transfer between EMS staff and Emergency Medicine Assistants during handover of trauma patients. Prehosp Disaster Med. 2017;32(5):541-547.
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Liljamo P, Kinnunen UM, Ohtonen P, Saranto K. Quality of nursing intensity data: inter-rater reliability of the patient classification after two decades in clinical use. J Adv Nurs 2017; 73:2248-2259. [PMID: 28252207 DOI: 10.1111/jan.13288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to measure the inter-rater reliability of the Oulu Patient Classification and to discuss existing methods of reliability testing. BACKGROUND The Oulu Patient Classification, part of the RAFAELA® System, has been developed to assist nursing managers with the proper allocation of nursing resources. Due to the increased intensity of inpatient care during recent years, there is a need for the reliability testing of the classification, which has been in clinical use for 20 years. DESIGN Retrospective statistical study. METHODS To test inter-rater reliability, a pair of nurses classified the same patients, without knowledge of each other's ratings, as a part of annually conducted standardization. Data on the parallel classifications (n = 19,997) was obtained from inpatient units (n = 32) with different specialties at a university hospital in Finland during 2010-2015. Parallel classification practices were also analysed. The reliability of the overall classification and its subareas were calculated using suitable statistical coefficients. RESULTS Inter-rater reliability coefficients were a reliable or almost perfect means of considering the nursing intensity category and various practices, but there were detectable differences between subareas. The lowest agreement levels occurred in the subareas 'Planning and Coordination of Nursing Care' and 'Guiding of Care/Continued Care and Emotional Support'. CONCLUSIONS There is a need to develop the descriptions of subareas and to clarify the related concepts. Precise nursing documentation can promote a high level of agreement and reliable results. The traditional overall proportion of agreement does not provide an adequate picture of reliability - weighted kappa coefficients should be used instead.
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Affiliation(s)
- Pia Liljamo
- Division of Operative Care, Oulu University Hospital, Finland
| | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Buus N, Hoeck B, Hamilton BE. Nurses' shift reports: a systematic literature search and critical review of qualitative field studies. J Clin Nurs 2017; 26:2891-2906. [PMID: 27874980 DOI: 10.1111/jocn.13655] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To identify reporting practices that feature in studies of nurses' shift reports across diverse nursing specialities. The objectives were to perform an exhaustive systematic literature search and to critically review the quality and findings of qualitative field studies of nurses' shift reports. BACKGROUND Nurses' shift reports are routine occurrences in healthcare organisations that are viewed as crucial for patient outcomes, patient safety and continuity of care. Studies of communication between nurses attend primarily to 1:1 communication and analyse the adequacy and accuracy of patient information and feature handovers at the bedside. Still, verbal reports between groups of nurses about patients are commonplace. Shift reports are obvious sites for studying the situated accomplishment of professional nursing at the group level. This review is focused exclusively on qualitative field research for nuanced and contextualised insights into nurses' everyday shift reporting practices. DESIGN The study is a systematic literature search and critical review of qualitative field analyses of nurses' shift reports. We searched in the databases CIHAHL, PubMed and PsycINFO and identified and reviewed 19 articles published 1992-2014. Data were systematically extracted using criteria for the evaluation of qualitative research reports. RESULTS The studies described shift report practices and identified several factors contributing to distribution of clinical knowledge. Shift report practices were described as highly conventionalised and locally situated, but with occasional opportunities for improvisation and negotiation between nurses. Finally, shift reports were described as multifunctional meetings, with individual and social effects for nurses and teams. CONCLUSION Innovations in between-shift communications can benefit from this analysis, by providing for the many functions of handovers that are revealed in field studies. RELEVANCE TO CLINICAL PRACTICE Leaders and practising nurses may consider what are the best opportunities for nurses to work up clinical knowledge and negotiate care.
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Affiliation(s)
- Niels Buus
- Faculty of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia.,St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,St. Vincent's Private Hospital Sydney, Darlinghurst, NSW, Australia
| | - Bente Hoeck
- Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Rixon S, Braaf S, Williams A, Liew D, Manias E. The functions and roles of questioning during nursing handovers in specialty settings: an ethnographic study. Contemp Nurse 2016; 53:182-195. [DOI: 10.1080/10376178.2016.1258316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sascha Rixon
- Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia
| | - Sandra Braaf
- Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Campus, Melbourne, VIC 3004, Australia
| | - Allison Williams
- School of Nursing and Midwifery, Monash University, Clayton Campus, Clayton, VIC 3168, Australia
| | - Danny Liew
- The Melbourne EpiCentre (Collaborative Centre for Clinical Epidemiology, Biostatistics and Health Services Research), c/- The Royal Melbourne Hospital, 7 East, Main Building, Grattan Street, Parkville, VIC 3050, Australia
| | - Elizabeth Manias
- Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Royal Parade, Parkville, VIC 3052, Australia
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Birmingham P, Buffum MD, Blegen MA, Lyndon A. Handoffs and Patient Safety: Grasping the Story and Painting a Full Picture. West J Nurs Res 2015; 37:1458-78. [PMID: 24951369 PMCID: PMC4272331 DOI: 10.1177/0193945914539052] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Effective handoff communication is critical for patient safety. Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. The purpose of this qualitative study was to examine medical-surgical nurses' (n = 21) perspectives about processes that promote and hinder patient safety intra-shift and during handoff. Results indicated that offgoing nurses' ability to grasp the story intra-shift was essential to convey the full picture during handoff. When oncoming nurses understood the picture being conveyed at the handoff, nurses jointly painted a full picture. Arriving and leaving the handoff with this level of information promoted patient safety. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Improvement efforts need to target the different processes involved in grasping the story and painting a full picture. Future research needs to examine handoff practices and outcomes on units with good and poor practice environments.
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Affiliation(s)
| | - Martha D Buffum
- San Francisco Veterans Affairs Medical Center, USA University of California, San Francisco, USA
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Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. Nursing unit leaders' influence on the long-term sustainability of evidence-based practice improvements. J Nurs Manag 2015; 24:309-18. [DOI: 10.1111/jonm.12320] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sonia E. Semenic
- Ingram School of Nursing; McGill University; Montreal QC Canada
- McGill University Health Centre (MUHC); Montreal QC Canada
| | - Judith A. Ritchie
- Ingram School of Nursing; McGill University; Montreal QC Canada
- École nationale d'administration publique (ENAP); Montreal QC Canada
| | - Marie-Claire Richer
- Ingram School of Nursing; McGill University; Montreal QC Canada
- McGill University Health Centre (MUHC); Montreal QC Canada
| | - Jean-Louis Denis
- École nationale d'administration publique (ENAP); Montreal QC Canada
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Abraham C, Junglas I, Watson RT, Boudreau MC. Explaining the unexpected and continued use of an information system with the help of evolved evolutionary mechanisms. J Assoc Inf Sci Technol 2015. [DOI: 10.1002/asi.23344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Chon Abraham
- Department of Operations and Information Systems Management, Mason School of Business; College of William and Mary; 101 Ukrop Way Williamsburg VA 23185
| | - Iris Junglas
- Department of Entrepreneurship, Strategy and Information Systems; Florida State University; 821 Academic Way Tallahassee FL 32306
| | - Richard T. Watson
- Terry College of Business, Management Information Systems; University of Georgia; 310 Herty Drive Athens GA 30602-6273
| | - Marie-Claude Boudreau
- Terry College of Business, Management Information Systems; University of Georgia; 310 Herty Drive Athens GA 30602-6273
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Foster-Hunt T, Parush A, Ellis J, Thomas M, Rashotte J. Information structure and organisation in change of shift reports: An observational study of nursing hand-offs in a Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2014; 31:155-64. [PMID: 25456856 DOI: 10.1016/j.iccn.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 08/10/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022]
Abstract
Patient hand-offs involve the exchange of critical information. Ineffective hand-offs can result in reduced patient safety by leading to wrong treatment, delayed diagnoses or other outcomes that can negatively affect the healthcare system. The objectives of this study were to uncover the structure of the information conveyed during patient hand-offs and look for principles characterising the organisation of the information. With an observational study approach, data was gathered during the morning and evening nursing change of shift hand-offs in a Paediatric Intensive Care Unit. Content analysis identified a common meta-structure used for information transfer that contained categories with varying degrees of information integration and the repetition of high consequence information. Differences were found in the organisation of the hand-off structures, and these varied as a function of nursing experience. The findings are discussed in terms of the potential benefits of computerised tools which utilise standardised structure for information transfer and the implications for future education and critical care skill acquisition.
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Affiliation(s)
| | - Avi Parush
- Carleton University, Ottawa, Ontario, Canada.
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16
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Holly C, Poletick EB. A systematic review on the transfer of information during nurse transitions in care. J Clin Nurs 2014; 23:2387-95. [PMID: 23786673 DOI: 10.1111/jocn.12365] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the qualitative evidence on dynamics of knowledge transfer during transitions in care in acute care hospitals. BACKGROUND The most common transition between nurse care providers is the intershift handoff. As these handoffs tend to be time-consuming and costly, it is important to understand the dynamics of the transfer of information at this time and, by extension, improve quality and safety. DESIGN Systematic Review. METHODS Qualitative studies conducted between 1988 and 2012 were sought. A comprehensive four-stage search strategy identified 125 qualitative studies that met the inclusion criteria. Of these, 50 were retrieved for appraisal. Retrieved papers were assessed by two independent reviewers for methodological quality prior to inclusion in the review using a standardised critical appraisal instrument. RESULTS The final sample consisted of 29 qualitative studies. This represented more than 800 nursing handoffs and 300 nurse interviews. Sixteen categories were identified, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesised findings. CONCLUSION The evidence shows the handoff to be a complex, social interaction highly sensitive to context and cultural norms, an activity essential to multiple functions that extend beyond quality and safety. They are subject to wide variability in both the methods used and the kind of information that is handed off. Notably, the elucidation of the different ways in which individual nurses act as gatekeepers and influence patient care is a major finding of this review. RELEVANCE TO CLINICAL PRACTICE The results of this systemic review provide evidence that a consistent guideline may provide an optimal shift report given the findings of this review that information transferred may be random and variable, inconsistent and incongruent, inaccurate or absent.
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Affiliation(s)
- Cheryl Holly
- New Jersey Center for Evidenced Based Practice, University of Medicine and Dentistry of New Jersey School of Nursing, Newark, NJ, USA
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17
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Abraham J, Kannampallil T, Patel VL. A systematic review of the literature on the evaluation of handoff tools: implications for research and practice. J Am Med Inform Assoc 2014; 21:154-62. [PMID: 23703824 PMCID: PMC3912721 DOI: 10.1136/amiajnl-2012-001351] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 04/26/2013] [Accepted: 04/27/2013] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Given the complexities of the healthcare environment, efforts to develop standardized handoff practices have led to widely varying manifestations of handoff tools. A systematic review of the literature on handoff evaluation studies was performed to investigate the nature, methodological, and theoretical foundations underlying the evaluation of handoff tools and their adequacy and appropriateness in achieving standardization goals. METHOD We searched multiple databases for articles evaluating handoff tools published between 1 February 1983 and 15 June 2012. The selected articles were categorized along the following dimensions: handoff tool characteristics, standardization initiatives, methodological framework, and theoretical perspectives underlying the evaluation. RESULTS Thirty-six articles met our inclusion criteria. Handoff evaluations were conducted primarily on electronic tools (64%), with a more recent focus on electronic medical record-integrated tools (36% since 2008). Most evaluations centered on intra-departmental tools (95%). Evaluation studies were quasi-experimental (42%) or observational (50%), with a major focus on handoff-related outcome measures (94%) using predominantly survey-based tools (70%) with user satisfaction metrics (53%). Most of the studies (81%) based their evaluation on aspects of standardization that included continuity of care and patient safety. CONCLUSIONS The nature, methodological, and theoretical foundations of handoff tool evaluations varied significantly in terms of their quality and rigor, thereby limiting their ability to inform strategic standardization initiatives. Future research should utilize rigorous, multi-method qualitative and quantitative approaches that capture the contextual nuances of handoffs, and evaluate their effect on patient-related outcomes.
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Affiliation(s)
- Joanna Abraham
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY, USA
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18
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Sabet Sarvestani R, Moattari M, Nasrabadi AN, Momennasab M, Yektatalab S. Challenges of Nursing Handover. Clin Nurs Res 2013; 24:234-52. [DOI: 10.1177/1054773813508134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore the challenges of nursing handover process during shift rotation in hospitals. The research had a descriptive exploratory design with a qualitative content analysis approach. To conduct the study, three pediatric wards were selected at first. Data were gathered through a 4-month observation of nursing handovers by recording the oral conversations of nurses during the process and semistructured interviews. Then, qualitative content analysis was used for data analysis. Two major themes and five subthemes emerged through the data analysis. The first and the second themes were a nonholistic approach and poor management, respectively. In general, applying a holistic approach and managing handover situations are recommended for nursing managers to overcome handover challenges. Future focus could be on addressing handover challenges through an action research study.
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Abraham J, Kannampallil TG, Almoosa KF, Patel B, Patel VL. Comparative evaluation of the content and structure of communication using two handoff tools: implications for patient safety. J Crit Care 2013; 29:311.e1-7. [PMID: 24360818 DOI: 10.1016/j.jcrc.2013.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/15/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE 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. METHOD 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Joanna Abraham
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois, Chicago, IL.
| | - Thomas G Kannampallil
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY
| | - Khalid F Almoosa
- Department of Internal Medicine, Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX
| | - Bela Patel
- Department of Internal Medicine, Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX
| | - Vimla L Patel
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY
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Younan LA, Fralic MF. Using “Best-Fit” Interventions to Improve the Nursing Intershift Handoff Process at a Medical Center in Lebanon. Jt Comm J Qual Patient Saf 2013; 39:460-7. [DOI: 10.1016/s1553-7250(13)39059-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Malekzadeh J, Mazluom SR, Etezadi T, Tasseri A. A standardized shift handover protocol: improving nurses' safe practice in intensive care units. J Caring Sci 2013; 2:177-85. [PMID: 25276725 PMCID: PMC4134157 DOI: 10.5681/jcs.2013.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. METHODS In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses' Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. RESULTS Study findings revealed that nurses' mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7) to 17.0 (1.8) (P < 0.001). CONCLUSION using a standard handover protocol for communicating patient's needs and information improves nurses' safe practice in the area of basic nursing care.
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Affiliation(s)
- Javad Malekzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazluom
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran
| | - Toktam Etezadi
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran
| | - Alireza Tasseri
- Department of Nursing, Javad-Al- Aemeh Hospital, Mashhad, Iran
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Matney SA, Maddox LJ, Staggers N. Nurses as knowledge workers: is there evidence of knowledge in patient handoffs? West J Nurs Res 2013; 36:171-90. [PMID: 23887437 DOI: 10.1177/0193945913497111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient care handoffs are critical to ensuring continuity of care and patient safety. Current definitions of handoffs focus on information, but preventing errors and improving quality require knowledge. The objective of this study was to determine whether knowledge and wisdom were exchanged during medical and surgical patient care handoffs and to discover how these were expressed. The study was a directed content analysis of 93 handoffs using the data/information/knowledge/wisdom framework. Results indicated knowledge was present in all handoffs, comprising 41% of the phrases across the two types of units. No wisdom was coded. The percentage and types of knowledge phrases differed between medical and surgical units. Handoffs could be more knowledge based by linking handoff content to patient problems and goals. Future handoffs could be computationally derived, context-specific, and linked to problem-focused care plans and patient summaries. Improved data visualization and cognitive support are needed.
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Block M, Ehrenworth JF, Cuce VM, Ng'ang'a N, Weinbach J, Saber S, Milic M, Urgo JA, Sokoli D, Schlesinger MD, Sexton JB. Measuring handoff quality in labor and delivery: development, validation, and application of the Coordination of Handoff Effectiveness Questionnaire (CHEQ). Jt Comm J Qual Patient Saf 2013; 39:213-20. [PMID: 23745480 DOI: 10.1016/s1553-7250(13)39028-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A prospective, nonblinded intervention study was conducted (1) to evaluate the psychometric properties of a new questionnaire, the CHEQ (Coordination of Handoff Effectiveness Questionnaire) for measuring the quality of handoff interactions in labor and delivery (L&D) and (2) to demonstrate the utility of the CHEQ in evaluating the effectiveness of a previously described intervention, the tangible handoff, for standardizing handoffs in L&D. METHODS The CHEQ incorporates three existing handoff-related scales: teamwork climate, job satisfaction, and burnout. Two new scales--information quality and process quality--were developed, refined, and evaluated. The CHEQ was administered to 56 eligible L&D nurses pre- and post-implementation of the tangible handoff intervention. RESULTS Baseline and postintervention response rates for the CHEQ were 98% and 84%, respectively. Overall, the teamwork climate scale significantly improved from 57.17% to 68.35% (t = -2.84, p = .006), and the burnout scale significantly decreased from 49.70% to 36.21% (t = -2.56, p = .012) following implementation of the tangible handoff. Job satisfaction improved, although not at a statistically significant level. Cronbach's alpha results ranged from .68 to .96 for all scales, both pre- and post-intervention. CONCLUSIONS The CHEQ is psychometrically sound for evaluating handoffquality, is practical to administer, achieves high response rates, and is amenable to straightforward statistical analysis. The CHEQ is useful for evaluating handoff quality and gauging the responsiveness to a unit-level intervention in the scope of unit-level climate. The CHEQ may be replicated or adapted for other clinical areas to investigate handoffs and inform the design and evaluation of handoff interventions.
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Affiliation(s)
- Michael Block
- Department of Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
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Flemming D, Hübner U. How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review. Int J Med Inform 2013; 82:580-92. [DOI: 10.1016/j.ijmedinf.2013.03.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 03/17/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
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Hunter J, Freer Y, Gatt A, Reiter E, Sripada S, Sykes C. Automatic generation of natural language nursing shift summaries in neonatal intensive care: BT-Nurse. Artif Intell Med 2012; 56:157-72. [DOI: 10.1016/j.artmed.2012.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 09/11/2012] [Accepted: 09/19/2012] [Indexed: 11/25/2022]
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Johnson M, Jefferies D, Nicholls D. Exploring the structure and organization of information within nursing clinical handovers. Int J Nurs Pract 2012; 18:462-70. [DOI: 10.1111/j.1440-172x.2012.02059.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Diana Jefferies
- School of Nursing & Midwifery; University of Western Sydney; Penrith South. DC; New South Wales; Australia
| | - Daniel Nicholls
- Clinical Chair in Mental Health Nursing Disciplines of Nursing & Midwifery; Faculty of Health; University of Canberra; Australian Capital Territory; Australia
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Foster S, Manser T. The effects of patient handoff characteristics on subsequent care: a systematic review and areas for future research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:1105-1124. [PMID: 22722354 DOI: 10.1097/acm.0b013e31825cfa69] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To summarize the available evidence about patient handoff characteristics and their impact on subsequent patient care in hospitals. METHOD In January and February 2011, the authors searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, PsycINFO, ERIC, ISI Web of Science, and the reference lists of relevant articles to carry out their systematic review. They selected articles that (1) had patient handoffs in hospitals as their explicit research focus and (2) reported at least one statistical test of an association between a handoff characteristic and outcome. They assessed study quality using 11 quality indicators. RESULTS The authors identified 18 articles reporting 37 statistical associations between a handoff characteristic and outcome. The only handoff characteristic investigated in more than one study was the use of a standardized handoff sheet. Seven of those 12 studies reported significant improvements after introduction of the sheet. Four of the 18 studies used a randomized controlled trial design. CONCLUSIONS Published research is highly diverse and idiosyncratic regarding the handoff characteristics and outcomes assessed and the methodologies used, so comparing studies and drawing general conclusions about the field are difficult endeavors. The quality of research on the topic is rather preliminary, and there is not yet enough research to inform evidence-based handoff strategies. Future research, then, should focus on research methods, which outcomes should be assessed, handoff characteristics beyond information transfer, mechanisms that link handoff characteristics and outcomes, and the conditions that moderate the characteristics' effects.
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Affiliation(s)
- Simon Foster
- Center for Organizational and Occupational Sciences, ETH Zurich, Zurich, Switzerland.
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Blending evidence and innovation: improving intershift handoffs in a multihospital setting. J Nurs Care Qual 2012; 27:116-24. [PMID: 22192937 DOI: 10.1097/ncq.0b013e318241cb3b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ineffective handoffs have been identified as a barrier to patient safety and quality and as a key area for improvement. Handoffs require a process for effective transfer of critical information. A redesigned nurse-to-nurse intershift handoff was implemented in 7 hospitals of a multisite system. The redesign included combining evidence and an innovative approach developed by nurse managers to improve intershift report. Results included an increase in nurse and patient satisfaction.
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Staggers N, Blaz JW. Research on nursing handoffs for medical and surgical settings: an integrative review. J Adv Nurs 2012; 69:247-62. [DOI: 10.1111/j.1365-2648.2012.06087.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Nancy Staggers
- School of Nursing; University of Maryland; Baltimore; Maryland; USA
| | - Jacquelyn W. Blaz
- Nursing Informatics; College of Nursing; University of Utah; Salt Lake City; Utah; USA
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31
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Bridging gaps in handoffs: A continuity of care based approach. J Biomed Inform 2012; 45:240-54. [DOI: 10.1016/j.jbi.2011.10.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/29/2011] [Accepted: 10/30/2011] [Indexed: 11/17/2022]
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Collins SA, Mamykina L, Jordan D, Stein DM, Shine A, Reyfman P, Kaufman D. In search of common ground in handoff documentation in an Intensive Care Unit. J Biomed Inform 2011; 45:307-15. [PMID: 22142947 DOI: 10.1016/j.jbi.2011.11.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/20/2011] [Accepted: 11/17/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Handoff is an intra-disciplinary process, yet the flow of critical handoff information spans multiple disciplines. Understanding this information flow is important for the development of computer-based tools that supports the communication and coordination of patient care in a multi-disciplinary and highly specialized critical care setting. We aimed to understand the structure, functionality, and content of nurses' and physicians' handoff artifacts. DESIGN We analyzed 22 nurses' and physicians' handoff artifacts from a Cardiothoracic Intensive Care Unit (CTICU) at a large urban medical center. We combined artifact analysis with semantic coding based on our published Interdisciplinary Handoff Information Coding (IHIC) framework for a novel two-step data analysis approach. RESULTS We found a high degree of structure and overlap in the content of nursing and physician artifacts. Our findings demonstrated a non-technical, yet sophisticated, system with a high degree of structure for the organization and communication of patient data that functions to coordinate the work of multiple disciplines in a highly specialized unit of patient care. LIMITATIONS This study took place in one CTICU. Further work is needed to determine the generalizability of the results. CONCLUSIONS Our findings indicate that the development of semi-structured patient-centered interdisciplinary handoff tools with discipline specific views customized for specialty settings may effectively support handoff communication and patient safety.
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Affiliation(s)
- Sarah A Collins
- Nurse Informatician, Clinical Informatics R&D, Partners Healthcare Systems, 93 Worcester St., Wellesley, MA 02481, USA.
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Mayor E, Bangerter A, Aribot M. Task uncertainty and communication during nursing shift handovers. J Adv Nurs 2011; 68:1956-66. [DOI: 10.1111/j.1365-2648.2011.05880.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Johnson M, Jefferies D, Nicholls D. Developing a minimum data set for electronic nursing handover. J Clin Nurs 2011; 21:331-43. [DOI: 10.1111/j.1365-2702.2011.03891.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Staggers N, Clark L, Blaz JW, Kapsandoy S. Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations. Health Informatics J 2011; 17:209-23. [DOI: 10.1177/1460458211405809] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses’ use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor’s electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer “at a glance” information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.
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Collins SA, Bakken S, Vawdrey DK, Coiera E, Currie L. Clinician preferences for verbal communication compared to EHR documentation in the ICU. Appl Clin Inform 2011; 2:190-201. [PMID: 23616870 DOI: 10.4338/aci-2011-02-ra-0011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 04/22/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication. OBJECTIVE We aimed to understand the current patterns and perceptions of communication of common goals in the ICU using the distributed cognition and clinical communication space theoretical frameworks. METHODS We conducted a focus group and 5 interviews with ICU clinicians and observed 59.5 hours of interdisciplinary ICU morning rounds. RESULTS Clinicians used an EHR system, which included electronic documentation and computerized provider order entry (CPOE), and paper artifacts for documentation; yet, preferred the verbal communication space as a method of information exchange because they perceived that the documentation was often not updated or efficient for information retrieval. These perceptions that the EHR is a "shift behind" may lead to a further reliance on verbal information exchange, which is a valuable clinical communication activity, yet, is subject to information loss. CONCLUSIONS Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication.
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Affiliation(s)
- S A Collins
- Department of Biomedical Informatics , Columbia University
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37
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Manser T, Foster S. Effective handover communication: An overview of research and improvement efforts. Best Pract Res Clin Anaesthesiol 2011; 25:181-91. [DOI: 10.1016/j.bpa.2011.02.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 02/18/2011] [Indexed: 01/22/2023]
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Staggers N, Clark L, Blaz JW, Kapsandoy S. Nurses’ Information Management and Use of Electronic Tools During Acute Care Handoffs. West J Nurs Res 2011; 34:153-73. [DOI: 10.1177/0193945911407089] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little evidence is available about nurses’ use of electronic tools during handoffs. This qualitative study explored information management and use of electronic tools during nursing handoffs. The sample included 93 handoffs by 26 nurses on 5 medical/surgical units in 2 western hospitals with a robust electronic health record (EHR). Data collection included audiotaping handoffs, semi-structured interviews, observations, and fieldnotes. The dataset was inductively coded into 33 categories and 5 themes: good nurse expectations for handoffs, paper forms are best, information at a glance, only pertinent information please, and information tools that work. Two-thirds of the nurses abandoned use of the leadership-endorsed electronic handoff form, preferring personal paper forms. The findings suggest effective electronic solutions will require extensive contextually-based information, information integrated across EHR modules and portable, electronic support throughout shifts. This is a call to action for leaders and informaticists as they select and design future electronic tools.
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Model development for EHR interdisciplinary information exchange of ICU common goals. Int J Med Inform 2010; 80:e141-9. [PMID: 20974549 DOI: 10.1016/j.ijmedinf.2010.09.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE Effective interdisciplinary exchange of patient information is an essential component of safe, efficient, and patient-centered care in the intensive care unit (ICU). Frequent handoffs of patient care, high acuity of patient illness, and the increasing amount of available data complicate information exchange. Verbal communication can be affected by interruptions and time limitations. To supplement verbal communication, many ICUs rely on documentation in electronic health records (EHRs) to reduce errors of omission and information loss. The purpose of this study was to develop a model of EHR interdisciplinary information exchange of ICU common goals. METHODS The theoretical frameworks of distributed cognition and the clinical communication space were integrated and a previously published categorization of verbal information exchange was used. 59.5h of interdisciplinary rounds in a neurovascular ICU were observed and five interviews and one focus group with ICU nurses and physicians were conducted. RESULTS Current documentation tools in the ICU were not sufficient to capture the nurses' and physicians' collaborative decision-making and verbal communication of goal-directed actions and interactions. Clinicians perceived the EHR to be inefficient for information retrieval, leading to a further reliance on verbal information exchange. CONCLUSION The model suggests that EHRs should support: (1) information tools for the explicit documentation of goals, interventions, and assessments with synthesized and summarized information outputs of events and updates; and (2) messaging tools that support collaborative decision-making and patient safety double checks that currently occur between nurses and physicians in the absence of EHR support.
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Patterson ES, Wears RL. Patient handoffs: standardized and reliable measurement tools remain elusive. Jt Comm J Qual Patient Saf 2010; 36:52-61. [PMID: 20180437 DOI: 10.1016/s1553-7250(10)36011-9] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous quality improvement projects on patient handoffs have been conducted, yet standardized, reliable measurement tools remain elusive. HANDOFF QUALITY MEASURES CLASSIFIED BY PRIMARY HANDOFF PURPOSE The literature review, which yielded approximately 400 relevant articles, led to the identification of seven primary functions for patient handoffs, each of which implies different interventions to improve them: (1) Framing 1, information processing is the most prevalent in the patient handoff literature; (2) Framing 2, stereotypical narratives, emphasizes highlighting deviations from typical narratives, such as a patient who is allergic to the preferred antibiotic for treating his or her diagnosed condition; (3) Framing 3, resilience, takes advantage of the transparency of the thought processes revealed through the conversation to identify erroneous assumptions and actions; (4) Framing 4, accountability, emphasizes the transfer of responsibility and authority; (5) Framing 5, social interaction, considers the perspective of the participants in the exchange; (6) Framing 6, distributed cognition, addresses how a transfer to a new care provider affects a network of specialized practitioners performing dedicated roles who may or may not be transitioning at the same time; (7) Framing 7, cultural norms, relates to how group values (instantiated as social norms for acceptable behavior) in an organization or suborganization are negotiated and maintained over time. DISCUSSION The diversity of handoff measurement approaches suggests a lack of consensus about the primary purpose of a handoff, as well as about what interventions are most promising for improving handoff processes. Recognizing that there are simultaneously multiple purposes for handoffs is a critical precursor to quality improvement.
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Affiliation(s)
- Emily S Patterson
- Health Information Management and Systems Division, Ohio State University Medical Center, School of Allied Medical Professions, Columbus, Ohio, USA.
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Abstract
Communication failures during shift reports are a leading cause of sentinel events in the United States. Providing adequate information during change-of-shift reporting is essential to promoting patient safety. In addition, patients want to be more involved in decisions regarding their plan of care. The purpose of the article is to discuss how a stroke rehabilitation unit was able to implement bedside change-of-shift reporting to meet both of these goals.
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Affiliation(s)
- Dawn Laws
- Stroke Rehabilitation Unit, MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, USA.
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Riesenberg LA, Leisch J, Cunningham JM. Nursing Handoffs: A Systematic Review of the Literature. Am J Nurs 2010; 110:24-34; quiz 35-6. [DOI: 10.1097/01.naj.0000370154.79857.09] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Poletick EB, Holly C. A systematic review of nurses' inter-shift handoff reports in acute care hospitals. ACTA ACUST UNITED AC 2010; 8:121-172. [PMID: 27819937 DOI: 10.11124/01938924-201008040-00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE An inter-shift nursing handoff report is the exchange of patient care information for evidence-based nursing and midwifery from one nurse to another, and is a universal procedure used in hospitals to promote continuity of care. The objective of this review was to appraise and synthesize the best available qualitative evidence pertaining to the nursing handoff report at the time of shift change and make recommendations that can enhance the transfer of information between and among nurses, and by extension, improve patient care. INCLUSION CRITERIA The review considered qualitative studies that drew on the experiences of nurses at the time of inter-shift nursing handoff in acute care hospitals, and included designs such as phenomenology, grounded theory, narrative analysis, action research, ethnographic or cultural studies. SEARCH STRATEGY The search strategy sought to find both published and unpublished research papers. An initial search of the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical Inquiry/Find Systematic Review database was conducted. Following this, an extensive three stage search was conducted using PubMed, CINAHL, HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL, PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant world wide websites and search engines, such as Google Scholar and the Virginia Henderson Library of Sigma Theta Tau International. METHODOLOGICAL QUALITY Each paper was assessed independently, by two reviewers for methodological quality prior to inclusion in the review using the critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) developed by the Joanna Briggs Institute for Evidence Based Nursing and Midwifery. RESULTS A total of 21 qualitative papers were included in the review of the 42 papers retrieved. Twenty-one were excluded as they did not meet the inclusion criteria. Findings were extracted and a meta-synthesis conducted using JBI-QARI. Three syntheses about the process of handoffs at the time of inter-shift nurses' reports in acute care hospitals were derived: 1) An embedded hierarchy exists that influences the conduct of inter-shift nursing handoffs; 2) Participating in inter-shift nursing handoffs are a way of becoming acculturated into the nursing unit's norms, expectations and rituals; 3) The nurse is the gatekeeper of information handed off that is used for subsequent care decisions. CONCLUSION There is evidence to support that the current process of inter-shift nurses' reports serves several purposes in addition to transfer of information, including the development of group solidarity. It is apparent from this review that the nurse is the gatekeeper for the flow of information regarding patient care and chooses what information to impart and act upon. Multiple ways of transferring information are recommended for the inter-shift nursing handoff as a way to manage information decay or funneling and to address potential communication gaps due to in congruencies between the medical record, verbal handoff report and actual clinical condition. IMPLICATIONS FOR PRACTICE A consistent guideline is a prerequisite to formulating an optimal shift report given the findings of this review that the quality of information transferred is unpredictable. The guideline needs to take into consideration, not only the exchange of information, but that nurses handle patient information in personal ways. To that end, a one-page report pre-populated with patient demographics, recent vital signs, laboratory results, and other information which can be accessed and printed at point-of-care at the time of change of shift is recommended. IMPLICATIONS FOR RESEARCH As external agencies continue to call for hand-off standardization that may not, in and of itself, reduce risk, further research is needed to determine the associations between inter-shift nursing reports and patient outcomes. Practice model initiatives, such as SBAR (situation-background-assessment-results) need to be investigated to determine if these methods can prevent information loss, particularly in those areas where information decays quickly, such as the Intensive Care Unit. As well, the current shortage of nurses make the composition of the nursing team less stable with more temporary and part-time workers resulting in a decrease in the cohesiveness and social interaction necessary to becoming acculturated in a nursing unit This could present a barrier to communication of important information and contribute to information loss that needs to be investigated.
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Affiliation(s)
- Eilleen B Poletick
- 1. New Jersey Center for Evidenced Based Practice, University of Medicine and Dentistry of New Jersey, School of Nursing
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Abstract
Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse's work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses' work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.
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Portet F, Reiter E, Gatt A, Hunter J, Sripada S, Freer Y, Sykes C. Automatic generation of textual summaries from neonatal intensive care data. ARTIF INTELL 2009. [DOI: 10.1016/j.artint.2008.12.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Anderson JJ, Mokracek M, Lindy CN. A nursing quality program driven by evidence-based practice. Nurs Clin North Am 2009; 44:83-91, xi. [PMID: 19167551 DOI: 10.1016/j.cnur.2008.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
St. Luke's Episcopal Hospital in Houston established a best-practice council as a strategy to link nursing quality to evidence-based practice. Replacing a system based on reporting quality control and compliance, this Best Practice Council formed interdisciplinary teams, charged them each with a quality issue, and directed them to change practice as needed under the guidance of the St. Luke's Episcopal Hospital Evidence Based Practice Model. This article reviews the activities of the Best Practice Council and the projects of teams assigned to study best practice in (1) preventing bloodstream infection (related to central lines), (2) preventing patient falls, (3) assessing and preventing pressure ulcers, and (4) ensuring good hand-off communication.
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Affiliation(s)
- Jacqueline J Anderson
- Division of Nursing, Unit 82, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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