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Subramonian D, Krahn G, Wlodarczak J, Lamb L, Malherbe S, Skarsgard E, Patel M. Improved patient safety with a simplified operating room to pediatric intensive care unit handover tool (PATHQS). Front Pediatr 2024; 12:1327381. [PMID: 38328344 PMCID: PMC10847360 DOI: 10.3389/fped.2024.1327381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Patient handover is a crucial transition requiring a high level of coordination and communication. In the BC Children's Hospital (BCCH) pediatric intensive care unit (PICU), 10 adverse events stemming from issues that should have been addressed at the operating room (OR) to PICU handover were reported into the patient safety learning system (PSLS) within 1 year. We aimed to undertake a quality improvement project to increase adherence to a standardized OR to PICU handover process to 100% within a 6-month time frame. In doing so, the secondary aim was to reduce adverse events by 50% within the same 6-month period. Methods The model for improvement and a Plan, Do, Study, Act method of quality improvement was used in this project. The adverse events were reviewed to identify root causes. The findings were reviewed by a multidisciplinary inter-departmental group comprised of members from surgery, anesthesia, and intensive care. Issues were batched into themes to address the most problematic parts of handover that were contributing to risk. Intervention A bedside education campaign was initiated to familiarize the team with an existing handover standard. The project team then formulated a new simplified visual handover tool with the mnemonic "PATHQS" where each letter denoted a step addressing a theme that had been noted in the pre-intervention work as contributing to adverse events. Results Adherence to standardized handover at 6 months improved from 69% to 92%. This improvement was sustained at 12 months and 3 years after the introduction of PATHQS. In addition, there were zero PSLS events relating to handover at 6 and 12 months, with only one filed by 36 months. Notably, staff self-reporting of safety concerns during handover reduced from 69% to 13% at 6 months and 0% at 3 years. The PATHQS tool created in this work also spread to six other units within the hospital as well as to one adult teaching hospital. Conclusion A simplified handover tool built collaboratively between departments can improve the quality and adherence of OR to PICU handover and improve patient safety. Simplification makes it adaptable and applicable in many different healthcare settings.
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Affiliation(s)
- D. Subramonian
- Division of Biochemical Diseases, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - G. Krahn
- Division of Critical Care, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - J. Wlodarczak
- Office of Virtual Health, Provincial Health Services Authority, Vancouver, BC, Canada
| | - L. Lamb
- Division of General Surgery, BC Children’s Hospital, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - S. Malherbe
- Division of Cardiac Anesthesia, BC Children’s Hospital, Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada
| | - E. Skarsgard
- Division of General Surgery, BC Children’s Hospital, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - M. Patel
- Division of Critical Care, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Shaffer DW, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Springman S, Gurses AP. Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes. HUMAN FACTORS 2024; 66:271-293. [PMID: 35658721 PMCID: PMC11022309 DOI: 10.1177/00187208221086342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.
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Affiliation(s)
- Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin – Madison
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania
| | | | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
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Abraham J, Bartek B, Meng A, Ryan King C, Xue B, Lu C, Avidan MS. Integrating machine learning predictions for perioperative risk management: Towards an empirical design of a flexible-standardized risk assessment tool. J Biomed Inform 2023; 137:104270. [PMID: 36516944 DOI: 10.1016/j.jbi.2022.104270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical patients are complex, vulnerable, and prone to postoperative complications that can potentially be mitigated with quality perioperative risk assessment and management. Several institutions have incorporated machine learning (ML) into their patient care to improve awareness and support clinician decision-making along the perioperative spectrum. Recent research suggests that ML risk prediction can support perioperative patient risk monitoring and management across several situations, including the operating room (OR) to intensive care unit (ICU) handoffs. OBJECTIVES Our study objectives were threefold: (1) evaluate whether ML-generated postoperative predictions are concordant with clinician-generated risk rankings for acute kidney injury, delirium, pneumonia, deep vein thrombosis, and pulmonary embolism, and establish their associated risk factors; (2) ascertain clinician end-user suggestions to improve adoption of ML-generated risks and their integration into the perioperative workflow; and (3) develop a user-friendly visualization format for a tool to display ML-generated risks and risk factors to support postoperative care planning, for example, within the context of OR-ICU handoffs. METHODS Graphical user interfaces for postoperative risk prediction models were assessed for end-user usability through cognitive walkthroughs and interviews with anesthesiologists, surgeons, certified registered nurse anesthetists, registered nurses, and critical care physicians. Thematic analysis relying on an explanation design framework was used to identify feedback and suggestions for improvement. RESULTS 17 clinicians participated in the evaluation. ML estimates of complication risks aligned with clinicians' independent rankings, and related displays were perceived as valuable for decision-making and care planning for postoperative care. During OR-ICU handoffs, the tool could speed up report preparation and remind clinicians to address patient-specific complications, thus providing more tailored care information. Suggestions for improvement centered on electronic tool delivery; methods to build trust in ML models; modifiable risks and risk mitigation strategies; and additional patient information based on individual preferences (e.g., surgical procedure). CONCLUSIONS ML estimates of postoperative complication risks can provide anticipatory guidance, potentially increasing the efficiency of care planning. We have offered an ML visualization framework for designing future ML-augmented tools and anticipate the development of tools that recommend specific actions to the user based on ML model output.
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Affiliation(s)
- Joanna Abraham
- Institute for Informatics, School of Medicine, Washington University in St Louis, MO, United States; Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States.
| | - Brian Bartek
- Institute for Informatics, School of Medicine, Washington University in St Louis, MO, United States
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States
| | - Christopher Ryan King
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States
| | - Bing Xue
- Department of Electrical & Systems Engineering, McKelvey School of Engineering, Washington University in St Louis, MO, United States
| | - Chenyang Lu
- Department of Computer Science & Engineering, McKelvey School of Engineering, Washington University in St Louis, MO, United States
| | - Michael S Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States
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Lazzara EH, Simonson RJ, Gisick LM, Griggs AC, Rickel EA, Wahr J, Lane-Fall MB, Keebler JR. Does standardisation improve post-operative anaesthesia handoffs? Meta-analyses on provider, patient, organisational, and handoff outcomes. ERGONOMICS 2022; 65:1138-1153. [PMID: 35438045 DOI: 10.1080/00140139.2021.2020341] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
Anaesthesia handoffs are associated with negative outcomes (e.g. inappropriate treatments, post-operative complications, and in-hospital mortality). To minimise these adverse outcomes, federal bodies (e.g. Joint Commission) have mandated handoff standardisation. Due to the proliferation of handoff interventions and research, there is a need to meta-analyze anaesthesia handoffs. Therefore, we performed meta-analyses on the provider, patient, organisational, and handoff outcomes related to post-operative anaesthesia handoff protocols. We meta-analysed 41 articles with post-operative anaesthesia handoffs that implemented a standardised handoff protocol. Compared to no standardisation, a standardised post-operative anaesthesia handoff changed provider outcomes with an OR of 4.03 (95% CI 3.20-5.08), patient outcomes with an OR of 1.49 (95% CI 1.32-1.69), organisational outcomes with an OR of 4.25 (95% CI 2.51-7.19), handoff outcomes with an OR of 8.52 (95% CI 7.05-10.31). Our meta-analyses demonstrate that standardised post-operative anaesthesia handoffs altered patient, provider, organisational, and handoff outcomes. Practitioner Summary: We conducted meta-analyses to assess the effects of post-operative anaesthesia handoff standardisation on provider, patient, organisational, and handoff outcomes. Our findings suggest that standardised post-operative anaesthesia handoffs changed all listed outcomes in a positive direction. We discuss the implications of these findings as well as notable limitations in this literature base.
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Affiliation(s)
- Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Richard J Simonson
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Logan M Gisick
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Andrew C Griggs
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Emily A Rickel
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Joyce Wahr
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Meghan B Lane-Fall
- David E. Longnecker Associate Professor of Anesthesiology and Critical Care, Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
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Toren O, Lipschuetz M, Lehmann A, Regev G, Arad D. Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project. Front Public Health 2022; 10:777678. [PMID: 35372215 PMCID: PMC8965813 DOI: 10.3389/fpubh.2022.777678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication. Methods This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process. Results Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87. Conclusions Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.
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Affiliation(s)
- Orly Toren
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Nursing Department, Ono Academic College, Kiryat Ono, Israel
| | - Michal Lipschuetz
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Gil Regev
- Psyfas, Teamwork and Healthcare, Herzliya, Israel
| | - Dana Arad
- Patient Safety Division, The Israeli Ministry of Health, Jerusalem, Israel
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Redley B, Njambi M, Rawson H. An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs. AORN J 2021; 113:621-634. [PMID: 34048035 DOI: 10.1002/aorn.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022]
Abstract
Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.
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Temsah MH, Abouammoh N, Ashry A, Al-Eyadhy A, Alhaboob A, Alsohime F, Almazyad M, Alabdulhafid M, Temsah R, Aljamaan F, Jamal A, Halwani R, Alhasan K, Al-Tawfiq JA, Barry M. Virtual Handover of Patients in the Pediatric Intensive Care Unit During the Covid-19 Crisis. J Multidiscip Healthc 2021; 14:1571-1581. [PMID: 34211276 PMCID: PMC8241813 DOI: 10.2147/jmdh.s310028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A key measure to mitigate coronavirus disease 2019 (COVID-19) has been social distancing. Incorporating video-conferencing applications in the patient handover process between healthcare workers can enhance social distancing while maintaining handover elements. This study describes pediatric intensive care unit (PICU) physicians' experience using an online video-conferencing application for handover during the COVID-19 pandemic. DESIGN Qualitative content analysis. SETTING PICU at a university hospital in Riyadh, Saudi Arabia. SUBJECTS PICU Physicians. INTERVENTIONS Due to the pandemic, the hospital's PICU used Zoom® as a remote conferencing application instead of a face-to-face handover. Following institutional review board approval, data were collected over two weeks (1 Jul 2020 to 14 Jul 2020). MEASUREMENTS An online survey was conducted using open-ended questions to capture demographic data and the perceived efficacy of remote handovers. Thematic framework analysis process included open coding, creating categories, and abstraction. MAIN RESULTS All 37 PICU physicians who participated in the handover completed the survey. The participants comprised six attendings, nine specialists, and 22 residents. While 20 (54.1%) physicians reported attending 1-5 Zoom handovers by the time of the study, some (n. 6, 16.2%) had more than ten virtual handovers. They had variable previous teleconferencing experiences. Most physicians (78.4%) were comfortable conducting a remote handover. Most found that Situation-Background-Assessment-Recommendation handover elements were properly achieved through this remote handover process. The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing. The perceived disadvantages were the paucity of nonverbal communication and teaching during virtual meetings. CONCLUSION Video-conferencing applications for online handovers could supplement traditional face-to-face intensive care unit patient handover during outbreaks of infectious diseases. The use of video streaming and more emphasis on teaching should be encouraged to optimize the users' experience.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Ashry
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alhaboob
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alsohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Almazyad
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Reem Temsah
- College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mazin Barry
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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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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Mortensen B, Borkowski N, O'Connor SJ, Patrician PA, Weech-Maldonado R. The Relationship Between Hospital Interdepartmental Transfers and Patient Experience. J Patient Exp 2020; 7:263-269. [PMID: 32851150 PMCID: PMC7427363 DOI: 10.1177/2374373519836467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the association between interdepartmental transfers and the perceptions of care received by adult patients who were admitted and discharged from a 300-bed, not-for-profit community tertiary hospital in the Midwest. Transfers of patient care are daily and frequent hospital processes. However, limited attention has focused on the effect that intrahospital transfers of care have on the patient experience. Understanding this relationship is important, since value-based purchasing models directly tie patient experience measures into hospital reimbursements. The key finding of this study indicates that as patients' transfers increase, their perceptions of care decrease. Therefore, by reducing the frequency of interdepartmental transfers, patient satisfaction may increase. This research provides clinicians and administrators a better understanding of the relationship between a frequent and a daily hospital process (ie, interdepartmental transfers) and its influence on patients' perceptions of their experience.
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Affiliation(s)
- Betty Mortensen
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nancy Borkowski
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen J O'Connor
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia A Patrician
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Weech-Maldonado
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
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Chalwin R, Giles L, Salter A, Kapitola K, Karnon J. Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls. BMC Health Serv Res 2020; 20:480. [PMID: 32471422 PMCID: PMC7257194 DOI: 10.1186/s12913-020-05260-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background Rapid Response Team (RRT) calls are clinical crises. Clinical and time pressures can hinder effective liaison between staff who call the RRT (‘users’) and those responding as part of the RRT (‘members’). Non-technical skills (NTS) training has been shown to improve communication and cooperation but requires time and financial resources that may not be available in acute care hospitals. Rapid Response System (RRS) re-design, aiming to promote use of NTS, may provide an alternative approach to improving interactions within RRTs and between members and users. Methods Re-design of an existing mature RRS was undertaken in a tertiary, metropolitan hospital incorporating the addition of: 1) regular RRT meetings 2) RRT role badges and 3) a structured member-to-user patient care responsibility “hand-off” process. To compare experiences and perceptions of calls, users and members were surveyed pre and post re-design. Results Post re-design there were improvements in members’ understanding of RRT roles (P = 0.03) and responsibilities (P < 0.01), and recollection of introducing themselves to users (P = 0.02). For users, after the re-design, there were improvements in identification of the RRT leader (P < 0.01), and in the development of clinical plans for patients remaining on the ward at the end of an RRT call (P < 0.01). However, post-re-design, fewer users agreed that the structured hand-off was useful or that they should be involved in the process. Both members and users reported fewer experiences of conflict at RRT calls post-re-design (both P < 0.01). Conclusion The RRS re-design yielded improvements in interactions between members in RRTs and between RRT members and users. However, some unintended consequences arose, particularly around user satisfaction with the structured hand-off. These findings suggest that refinement and improvement of the RRS is possible, but should be an ongoing iterative effort, ideally supported by staff training. Trial registration NCT01551160. Registered: 12th March 2012.
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Affiliation(s)
- Richard Chalwin
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia. .,Rapid Response System, Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia.
| | - Lynne Giles
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Amy Salter
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Karoline Kapitola
- Rapid Response System, Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia
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Kannampallil T, Abraham J. Listening and question-asking behaviors in resident and nurse handoff conversations: a prospective observational study. JAMIA Open 2020; 3:ooz069. [PMID: 32142114 PMCID: PMC7309249 DOI: 10.1093/jamiaopen/ooz069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/09/2019] [Accepted: 12/18/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize interactivity during resident and nurse handoffs by investigating listening and question-asking behaviors during conversations. MATERIALS AND METHODS Resident (n = 149) and nurse (n = 126) handoffs in an inpatient medicine unit were audio-recorded. Handoffs were coded based on listening behaviors (active and passive), question types (patient status, coordination of care, clinical reasoning, and framing and alignment), and question responses. Comparisons between residents and nurses for listening and question-asking behaviors were performed using the Wilcoxon rank-sum tests. A Poisson regression model was used to investigate differences in the question-asking behaviors between residents and nurses, and the association between listening and question-asking behaviors. RESULTS There were no significant differences between residents and nurses in their active (18% resident vs 39% nurse handoffs) or passive (88% resident vs 81% nurse handoffs) listening behaviors. Question-asking was common in resident and nurse handoffs (87% vs 98%) and focused primarily on patient status, co-ordination, and framing and alignment. Nurses asked significantly more questions than residents (Mresident = 2.06 and Mnurse = 5.52) by a factor of 1.76 (P < 0.001). Unit increase in listening behaviors was associated with an increase in the number of questions during resident and nurse handoffs by 7% and 12%, respectively. DISCUSSION AND CONCLUSION As suggested by the Joint Commission, question-asking behaviors were common across resident and nurse handoffs, playing a critical role in supporting resilience in communication and collaborative cross-checks during conversations. The role of listening in initiating question-asking behaviors is discussed.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology & Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Joanna Abraham
- Department of Anesthesiology & Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Germack HD, Fekieta R, Campbell Britton M, Feder SL, Rosenberg A, Chaudhry SI. Cooperation and conflict in intra-hospital transfers: A qualitative analysis. Nurs Open 2020; 7:634-641. [PMID: 32089862 PMCID: PMC7024622 DOI: 10.1002/nop2.434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/15/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022] Open
Abstract
Aim The purpose of this study was to explore the latent conditions of cooperation and conflict in intra-hospital patient transfers (i.e. transfers of patients between units in a hospital). Design Secondary qualitative analysis of 28 interviews conducted with 29 hospital staff, including physicians (N = 13), nurses (N = 10) and support staff (N = 6) from a single, large academic tertiary hospital in the Northeastern United States. Methods A two-member multidisciplinary team applied a directed content analysis approach to data collected from semi-structured interviews. Results Three recurrent themes were generated: (a) patient flow policies created imbalances of power; (b) relationships were helpful to facilitate safe transfers; and (c) method of admission order communication was a source of disagreement. Hospital quality improvement efforts could benefit from a teaming approach to minimize unintentional power imbalances and optimize communicative relationships between units.
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Affiliation(s)
- Hayley D. Germack
- National Clinician Scholars ProgramYale University School of MedicineNew HavenCTUSA
- Present address:
School of Nursing Department of Acute and Tertiary CareUniversity of PittsburghPittsburghPAUSA
| | - Renee Fekieta
- Department of Population HealthYale University School of MedicineNew HavenCTUSA
| | | | | | | | - Sarwat I. Chaudhry
- Department of Internal MedicineYale University School of MedicineNew HavenCTUSA
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Tuna R, Dalli B. The Turkish version of the Handover Evaluation Scale: A validity and reliability study. Int J Nurs Pract 2019; 25:e12787. [PMID: 31608567 DOI: 10.1111/ijn.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study is to adapt the English version of the Handover Evaluation Scale to a Turkish nursing sample. METHODS This is a methodological and cross-sectional study. This study was conducted with 192 nurses working in different units in a public hospital between September 2016 and January 2017. A descriptive information form and the Handover Evaluation Scale were used to collect data. First, language validity and content validity were determined regarding the adaptation of the scale. RESULTS As a result of the adaptation process, it was determined that the scale's structure, which consisted of 10 items and two factors explaining 68.96% of the total variance, was valid and reliable for the Turkish nursing sample. A Kaiser-Meyer-Olkin test and Bartlett's test of sphericity indicated that the sample met the criteria required for factor analysis. The reliability coefficient for the overall scale was 0.92. The test-retest reliability results were 0.87 for the overall intraclass correlation coefficient, and the t-test result was P > .05. CONCLUSION This adaptation study revealed that the scale is a valid and reliable tool for evaluation of the handover of Turkish nurses.
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Affiliation(s)
- Rujnan Tuna
- Department of Health Management, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Birsen Dalli
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
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Kannampallil T, Jones S, Abraham J. 'This is our liver patient…': use of narratives during resident and nurse handoff conversations. BMJ Qual Saf 2019; 29:135-141. [PMID: 31270253 DOI: 10.1136/bmjqs-2018-009268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Handoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations. METHOD We audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives. RESULTS Handoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, 'a liver patient'), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting 'heads up' anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management. DISCUSSION The presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Steve Jones
- Department of Communication, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Shah AC, Herstein AR, Flynn-O'Brien KT, Oh DC, Xue AH, Flanagan MR. Six Sigma Methodology and Postoperative Information Reporting: A Multidisciplinary Quality Improvement Study With Interrupted Time-Series Regression. JOURNAL OF SURGICAL EDUCATION 2019; 76:1048-1067. [PMID: 30954426 DOI: 10.1016/j.jsurg.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/22/2018] [Accepted: 12/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The postoperative handover is often compromised by reporting inconsistencies between different specialties. We describe a multidisciplinary quality improvement initiative to improve postoperative information reporting. DESIGN A quality improvement project with interrupted time-series data collection was undertaken in the postanesthesia care unit between January 2015 and August 2015. We utilized Six Sigma methodology to engage multispecialty stakeholders in identifying deficiencies in the existing postoperative handover process in January 2015. A standardized handover process including a checklist and electronic handover note was implemented within a postanesthesia care unit in June 2015. Direct observations of handovers were conducted to determine reporting accuracy, handover duration, and specialty representative attendance. Segmented linear and logistic regression analyses were used for interrupted time-series data. SETTING Single postanesthesia care unit at an academic tertiary referral center. PARTICIPANTS Physician trainees in anesthesia (n = 82) and surgical subspecialties (n = 139), certified registered nurse anesthetists (n = 57), and recovery room registered nurses (n = 139). RESULTS Cumulative handover scores increased by 18.3 points in the postimplementation period (n = 70) when compared to preimplementation handovers (n = 69), a finding which remained statistically significant after adjusting for preintervention time trends (difference 16 points; 95% confidence intervals 3-31; p = 0.021). No statistically significant difference in handover duration was seen between cohorts (6.8 minutes vs 6.1 minutes, difference 0.5 minutes; 95% confidence intervals -2.8 to 3.7; p = 0.78). Three years postimplementation, there was consistent use of a modified electronic handover note and surgical subspecialty attendance during handover. CONCLUSIONS A standardized handover process was associated with improved information reporting among different surgical disciplines without significantly lengthening handover duration.
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Affiliation(s)
- Aalap C Shah
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington; Independent Practice in Los Angeles, California.
| | - Andrew R Herstein
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington
| | | | - Daniel C Oh
- University of Washington School of Medicine, Seattle, Washington
| | - Anna H Xue
- University of Washington School of Medicine, Seattle, Washington
| | - Meghan R Flanagan
- Department of Surgery, University of Washington Medical Center, Seattle, Washington; Department of Surgery, University of Washington Medical Center, Seattle, Washington
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Pino FA, Sam KJ, Wood SL, Tafreshi PA, Parks SL, Bell PA, Hoffman EA, Koebel LM, St. Peter SD. Increasing Compliance with a New Interunit Handoff Process: A Quality Improvement Project. Pediatr Qual Saf 2019; 4:e180. [PMID: 31579878 PMCID: PMC6594785 DOI: 10.1097/pq9.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/30/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Current literature demonstrates that standardizing interunit patient handoff improves communication, information transfer, and patient safety. However, few studies have focused on increasing staff compliance with new handoff processes. The purpose of this quality improvement project was to incorporate both user input into process design and on-the-job coaching with a newly introduced nurse handoff process between the postanesthesia care unit and Medical/Surgical units. We hypothesized that staff compliance would be 100% within 90 days. METHODS The team's intervention consisted of (1) involving representative frontline nursing staff in the standardization and modification of the handoff process and (2) providing on-the-job coaching as the new process was being trialed at the bedside. We designed the handoff process during a 2-day workshop and a 1.5-week pilot. Data included the number of observed noncompliant process elements and handoff duration. Three sequential 30-day plan-do-study-act cycles were followed, during which compliance observations and user feedback were used to refine the design and coaching iteratively. RESULTS A total of 1,800 process elements were observed and coached throughout a 90-day trial period. The number of observed noncompliant elements decreased from 15% (92) to 4% (22) from the first 30-day interval to the final 30-day interval. There was no undesirable increase in handoff duration (mean, 8.05 ± 4.72 minutes), and several potential errors-related to orders, charting, and patient placement-were prevented by using the new handoff. CONCLUSIONS User input and on-the-job coaching resulted in iteratively increasing frontline compliance with a new standardized handoff process.
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Affiliation(s)
- Felicity A. Pino
- From the Performance Improvement, Children’s Mercy, Kansas City, MO
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO
- Bloch School of Management, University of Missouri-Kansas City, Kansas City, MO
| | - Kenneth J. Sam
- From the Performance Improvement, Children’s Mercy, Kansas City, MO
| | - Stacey L. Wood
- Perioperative Services, Children’s Mercy, Kansas City, MO
| | | | - Stacy L. Parks
- Medical/Surgical Services, Children’s Mercy, Kansas City, MO
| | | | | | | | - Shawn D. St. Peter
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO
- Department of Surgery, Children’s Mercy, Kansas City, MO
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Kannampallil T, Awadalla SS, Jones S, Abraham J. A graph-based approach for characterizing resident and nurse handoff conversations. J Biomed Inform 2019; 94:103178. [PMID: 31002936 DOI: 10.1016/j.jbi.2019.103178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
Prior research has used a variety of qualitative and quantitative approaches for studying handoff communication. Due to the dynamic and interactive nature of handoffs, characterizing the structure and content of these conversations is challenging. In this paper, we use a graph-based approach to characterize handoff communication as a conversation network. Conversation networks were used to compare the structural properties of resident-resident and nurse-nurse handoff communication. Resident (n = 149) and nurse (n = 126) handoff conversations from general medicine units were coded using a previously validated clinical content framework. The coded conversations were then translated into separate resident and nurse conversation networks, and were compared using 11 network measures. Transition probabilities were used to identify commonly repeating sub-networks within resident and nurse conversations. There were significant differences between resident and nurse conversation networks in 10 of the 11 network measures. There were also significant differences in the structure of conversations: compared to resident conversations, nurse conversations were focused on fewer clinical content categories and had more branching and switching between clinical content categories; however, there were clinically-relevant organic relationships in the order of presentation of clinical content among both resident and nurse handoff conversations. We discuss the potential for using graph-based approach as an alternative method for characterizing interactive conversations and also suggest future directions for using network-based approaches for analyzing handoff conversations.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology & Institute for Informatics, School of Medicine, Washington University in St Louis, St. Louis, MO, United States.
| | - Saria S Awadalla
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Steve Jones
- Department of Communication, College of Liberal Arts and Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Joanna Abraham
- Department of Anesthesiology & Institute for Informatics, School of Medicine, Washington University in St Louis, St. Louis, MO, United States
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Postoperative Information Transfers: An Integrative Review. J Perianesth Nurs 2019; 34:403-424.e3. [DOI: 10.1016/j.jopan.2018.06.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 06/03/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022]
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Bressan V, Cadorin L, Stevanin S, Palese A. Patients experiences of bedside handover: findings from a meta-synthesis. Scand J Caring Sci 2019; 33:556-568. [PMID: 30866081 DOI: 10.1111/scs.12673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bedside shift reports have been recently recommended to ensure handovers. However, no evidence summarising studies designed to determine the qualitative approaches capable of better understanding patient experience have been published to date. AIM The aim of this study was to acquire a deeper understanding of the experiences of patients regarding bedside shift reports. DATA SOURCES AND REVIEW METHODS A systematic review of qualitative studies followed by a meta-synthesis method based upon Sandelowski's and Barroso's guidelines was performed. Four databases were systematically explored (PubMed, CINAHL, Scopus and PsycINFO) without any limitation in time and up to the 31 August 2018. A total of 10 studies were included and evaluated in their methodological quality; then, a thematic synthesis was developed to synthetize the findings. RESULTS Three major themes reflect patients' experience regarding the bedside shift reports: (i) 'Being involved'; (ii) 'Being the centre of nursing care processes'; and (iii) 'Experiencing critical issues'. Patients are supportive of bedside shift reports as a right, as an opportunity to be involved, and of being in the centre of the nursing care process. By designing and implementing bedside shift reports, nurses also have an opportunity to increase patient safety and to provide concrete proof of the advancements achieved by the nursing profession in recent years. CONCLUSIONS The bedside shift reports experience has been little studied to date from the perspective of patients. According to the findings, implementation of the bedside shift reports should include providing education to nurses with regard to the preferences and expectations of patients, as well as the critical issues that they can experience during the bedside shift reports. Presenting the bedside shift reports method, asking patient consent, discussing potential critical issues and the degree of involvement preferred at hospital admission, is strongly recommended.
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Affiliation(s)
- Valentina Bressan
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
| | - Lucia Cadorin
- Continuing Education Centre, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano - Pordenone, Italy
| | | | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
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Impact of patient handover structure on neonatal perioperative safety. J Perinatol 2019; 39:453-467. [PMID: 30655594 PMCID: PMC6592629 DOI: 10.1038/s41372-018-0305-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the incidence, severity, preventability, and contributing factors of non-routine events-deviations from optimal care based on the clinical situation-associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates. STUDY DESIGN A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children's hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care. RESULTS The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement-Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers. CONCLUSIONS NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.
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"Do You Know What I Know?": How Communication Norms and Recipient Design Shape the Content and Effectiveness of Patient Handoffs. J Gen Intern Med 2019; 34:264-271. [PMID: 30535752 PMCID: PMC6374251 DOI: 10.1007/s11606-018-4755-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/30/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
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.
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Usher R, Cronin SN, York NL. Evaluating the Influence of a Standardized Bedside Handoff Process in a Medical-Surgical Unit. J Contin Educ Nurs 2019; 49:157-163. [PMID: 29596702 DOI: 10.3928/00220124-20180320-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient safety is a national and global concern. In the United States, medical errors result in more than 50,000 unnecessary patient deaths annually and contribute to billions of dollars in health care costs. The purpose of this project was to evaluate a standardized bedside handoff process and its influence in a medical-surgical unit. METHOD A quality improvement project was performed in a medical-surgical unit and consisted of development, implementation, and evaluation of a standardized bedside handoff. The project included surveying nurses, a web-based educational program, and observations using the SBAR (T) competency checklist tool. Data were analyzed for trends. RESULTS Results identified an improved perception of communication among the nurses as it relates to shift report and a reduction in length of handoff time after the education intervention. CONCLUSION Continual nurse education and audits by nurse leaders are vital to the sustainment of positive outcomes. J Contin Educ Nurs. 2018;49(4):157-163.
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Arora A, Kannampallil T, Abraham J. Interdisciplinary handover between obstetric nursing and neonatal physician teams: an observational study. BMJ Paediatr Open 2019; 3:e000432. [PMID: 31206078 PMCID: PMC6542453 DOI: 10.1136/bmjpo-2018-000432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/12/2019] [Accepted: 03/09/2019] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE We investigated the content and quality of communication of interservice interprofessional handover between obstetric nurses and neonatal physicians for high-risk deliveries. DESIGN Observational study. SETTING Labour and delivery unit at a tertiary care hospital. METHOD We audio-recorded handovers between obstetric and neonatal teams (n=50) and conducted clinician interviews (n=29). A handover content framework was developed and used to qualitatively code missing core and ancillary content and their potential for adverse events. RESULTS 26 (52%) handovers missed one or more clinical content elements; a third of the handovers missed at least one core clinical content element. Increase in the number of missed clinical content elements increased the odds of potential adverse events by 2.39 (95% CI1.18 to 5.37). Both residents and nurses perceived handovers to be of low quality and inconsistent and attributed it to the lack of a structured handover process. CONCLUSION Streamlining handover processes by instituting standardisation approaches for both information organisation and communication can improve the quality of neonatal handovers.
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Affiliation(s)
- Anshul Arora
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Joanna Abraham
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Rattray NA, Ebright P, Flanagan ME, Militello LG, Barach P, Franks Z, Rehman SU, Gordon HS, Frankel RM. Content counts, but context makes the difference in developing expertise: a qualitative study of how residents learn end of shift handoffs. BMC MEDICAL EDUCATION 2018; 18:249. [PMID: 30390668 PMCID: PMC6215683 DOI: 10.1186/s12909-018-1350-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Handoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents' perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs. METHODS A qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts. RESULTS Although some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients. CONCLUSIONS Residents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.
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Affiliation(s)
- Nicholas A. Rattray
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
- Department of Anthropology, Indiana University-Purdue University Indianapolis, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, USA
| | | | - Mindy E. Flanagan
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
| | | | - Paul Barach
- Wayne State University School of Medicine, Detroit, USA
| | - Zamal Franks
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
| | - Shakaib U. Rehman
- Phoenix VA Healthcare Systems, Phoenix, USA
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Howard S. Gordon
- VA HSR&D Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC, Chicago, USA
- University of Illinois at Chicago, Chicago, USA
| | - Richard M. Frankel
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
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Benjamin LS, Carney MM. Furthering the Value of the Emergency Department Beyond Its Walls: Transitions to the Medical Home for Pediatric Emergency Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Sumner BD, Grimsley EA, Cochrane NH, Keane RR, Sandler AB, Mullan PC, O'Connell KJ. Videographic Assessment of the Quality of EMS to ED Handoff Communication During Pediatric Resuscitations. PREHOSP EMERG CARE 2018; 23:15-21. [PMID: 30118642 DOI: 10.1080/10903127.2018.1481475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The National Association of Emergency Medical Services (EMS) Physicians emphasizes the importance of high quality communication between EMS providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration. OBJECTIVE This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations. METHODS/DESIGN We conducted a retrospective review of video recordings of pediatric patients who required critical care ("resuscitation") in the ED between January 2014 and February 2016 at a Level 1 pediatric trauma center. Handoff quality between EMS and emergency department teams was assessed for completeness, timeliness, and efficiency. Institutional review board approval was obtained. RESULTS Sixty-eight resuscitations were reviewed; 28% presented in cardiac arrest, requiring cardiopulmonary resuscitation (CPR). Completeness of information communicated was variable and included chief complaint (88%), prehospital interventions (81%), physical exam findings (63%), medical history (59%), age (56%), and weight (20%). Completeness of specific vital sign reporting included: respiratory rate (53%), heart rate (43%), oxygen saturation (39%), and blood pressure (31%). Timeliness of communication included median patient handoff and report times of 50 seconds [IQR 30,74] and 108 seconds [IQR 62,252], respectively. Inefficient communication occurred in 87% of handoffs, including interruptions by ED staff (51%), questions from the ED physician team leader asking for information already communicated (40%), and questions by ED physician team leader requesting information not yet communicated (65%). When comparing non-CPR to CPR cases, only timeliness of patient handoff was significantly different for those patients receiving prehospital CPR. CONCLUSION Handoff communication between EMS and ED teams during pediatric resuscitation was frequently incomplete and inefficient. Future educational and quality improvement interventions could aim to improve the quality of handoff communication for this patient population.
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Forde MF, Coffey A, Hegarty J. The factors to be considered when evaluating bedside handover. J Nurs Manag 2018; 26:757-768. [DOI: 10.1111/jonm.12598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mary F. Forde
- Doctoral Candidate, Nurse Practice Development Co-ordinator, Bon Secours Hospital; Cork Ireland
| | - Alice Coffey
- Catherine McAuley School of Nursing and Midwifery; University College Cork; Cork Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery; University College Cork; Cork Ireland
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Balhara KS, Peterson SM, Elabd MM, Regan L, Anton X, Al-Natour BA, Hsieh YH, Scheulen J, Stewart de Ramirez SA. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine. Intern Emerg Med 2018; 13:385-395. [PMID: 28155017 DOI: 10.1007/s11739-017-1615-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/18/2017] [Indexed: 01/20/2023]
Abstract
Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.
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Affiliation(s)
- Kamna S Balhara
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, MC 7736, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Susan M Peterson
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mohamed Moheb Elabd
- Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates
| | - Linda Regan
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Xavier Anton
- Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates
| | - Basil Ali Al-Natour
- Department of Emergency Medicine, Al Rahba Hospital, Abu Dhabi, United Arab Emirates
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - James Scheulen
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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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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Festekjian A, Mody AP, Chang TP, Ziv N, Nager AL. Novel Transfer of Care Sign-out Assessment Tool in a Pediatric Emergency Department. Acad Pediatr 2018; 18:86-93. [PMID: 28843485 DOI: 10.1016/j.acap.2017.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Transfer of care sign-outs (TOCS) for admissions from a pediatric emergency department have unique challenges. Standardized and reliable assessment tools for TOCS remain elusive. We describe the development, reliability, and validity of a TOCS assessment tool. METHODS Video recordings of resident TOCS were assessed to capture 4 domains: completeness, synopsis, foresight, and professionalism. In phase 1, 56 TOCS were used to modify the tool and improve reliability. In phase 2, 91 TOCS were used to examine validity. Analyses included Cronbach's alpha for internal structure, intraclass correlation and Cohen's kappa for interrater reliability, Pearson's correlation for relationships between variables, and 95% confidence interval of the mean for resident group comparisons. RESULTS Cronbach's alpha was 0.52 for internal structure of the tool's subjective rating scale. Intraclass correlation for the subjective rating scale items ranged from 0.70 to 0.80. Cohen's kappa for most objective checklist items ranged from 0.43 to 1. Content completeness was significantly correlated with synopsis, foresight, and professionalism (Pearson's r ranged from 0.36 to 0.62, P values were <0.001). House staff senior residents scored higher (on average) than interns and rotating senior residents in synopsis and foresight. Also, house staff interns scored higher (on average) than rotating senior residents in professionalism. House staff senior residents scored higher (on average) than rotating senior residents in content completeness. CONCLUSIONS We provide validity evidence to support using scores from the TOCS tool to assess higher-level transfer of care comprehension and communication by pediatric emergency department residents and to test interventions to improve TOCS.
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Affiliation(s)
- Ara Festekjian
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, Calif; Keck School of Medicine, University of Southern California, Los Angeles, Calif.
| | - Ameer P Mody
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, Calif; Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Todd P Chang
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, Calif; Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Nurit Ziv
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, Calif
| | - Alan L Nager
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, Calif; Keck School of Medicine, University of Southern California, Los Angeles, Calif
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Campion TR, Weinberg ST, Lorenzi NM, Waitman LR. Evaluation of Computerized Free Text Sign-Out Notes: Baseline Understanding and Recommendations. Appl Clin Inform 2017; 1:304-317. [PMID: 21258575 DOI: 10.4338/aci-2010-04-ra-0023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Standardization of sign-out, the transfer of patient information and responsibility between inpatient providers at shift change, is a Joint Commission National Patient Safety Goal intended to improve communication and reduce risk of error. Computerized systems with free text data entry and limited structure allow clinicians to generate sign-out notes in a variety of ways. OBJECTIVES: The literature lacks a systematic exploration of the range of content generated by users of computerized sign-out systems. The goal of this study was to determine if and how clinicians record standardized sign-out information using a system with free text data entry and limited structure. METHODS: Using qualitative methods, we reviewed free text sign-out notes for 730 patient cases across 39 hospital units at an academic medical center. RESULTS: Two categories of information expression emerged from analysis: patient treatment-comprised of patient summaries, awareness items, and action items-and care team coordination-consisting of discharge information, contact information, and social concerns. A third category describing the format of sign-out note content, presentation of information, also emerged. Location and structure of information varied, but sign-out note content for some hospital units exhibited specific characteristics and was relatively standardized. CONCLUSIONS: Findings provide a baseline understanding of computerized free text sign-out note content. Sign-out notes contained a synthesis of data from disparate sources. We recommend formalizing existing unit-specific content standardization and system use patterns to reduce sign-out note variability and improve communication.
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Affiliation(s)
- Thomas R Campion
- Vanderbilt University School of Medicine, Department of Biomedical Informatics
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Kitzmiller RR, Sitkin SB, Vidyarthi AR. Handoffs: what’s good for residents is good for nurses…so what’s next? BMJ Qual Saf 2017; 26:944-946. [DOI: 10.1136/bmjqs-2017-007010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/04/2022]
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Transitions of Care in the Perioperative Period. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Moore M, Roberts C, Newbury J, Crossley J. Am I getting an accurate picture: a tool to assess clinical handover in remote settings? BMC MEDICAL EDUCATION 2017; 17:213. [PMID: 29141622 PMCID: PMC5688655 DOI: 10.1186/s12909-017-1067-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 11/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Good clinical handover is critical to safe medical care. Little research has investigated handover in rural settings. In a remote setting where nurses and medical students give telephone handover to an aeromedical retrieval service, we developed a tool by which the receiving clinician might assess the handover; and investigated factors impacting on the reliability and validity of that assessment. METHODS Researchers consulted with clinicians to develop an assessment tool, based on the ISBAR handover framework, combining validity evidence and the existing literature. The tool was applied 'live' by receiving clinicians and from recorded handovers by academic assessors. The tool's performance was analysed using generalisability theory. Receiving clinicians and assessors provided feedback. RESULTS Reliability for assessing a call was good (G = 0.73 with 4 assessments). The scale had a single factor structure with good internal consistency (Cronbach's alpha = 0.8). The group mean for the global score for nurses and students was 2.30 (SD 0.85) out of a maximum 3.0, with no difference between these sub-groups. CONCLUSIONS We have developed and evaluated a tool to assess high-stakes handover in a remote setting. It showed good reliability and was easy for working clinicians to use. Further investigation and use is warranted beyond this setting.
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Affiliation(s)
- Malcolm Moore
- Rural Clinical School, Australian National University Medical School, 54 Mills Rd, Acton, ACT 2601 Australia
- Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, Australia
| | - Chris Roberts
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jonathan Newbury
- Rural Clinical School, University of Adelaide, Adelaide, Australia
| | - Jim Crossley
- Medical School, University of Sheffield, Sheffield, UK
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Randmaa M, Engström M, Swenne CL, Mårtensson G. The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses. BMJ Open 2017; 7:e015038. [PMID: 28780540 PMCID: PMC5724209 DOI: 10.1136/bmjopen-2016-015038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate different professionals' (nurse anaesthetists', anaesthesiologists', and postanaesthesia care unit nurses') descriptions of and reflections on the postoperative handover. DESIGN A focus group interview study with a descriptive design using qualitative content analysis of transcripts. SETTING One anaesthetic clinic at two hospitals in Sweden. PARTICIPANTS Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8). RESULTS Patterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals' perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient's privacy and that frequent interruptions could be disturbing. CONCLUSIONS The present findings revealed variations in different professionals' views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals' perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care.
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Affiliation(s)
- Maria Randmaa
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Nursing Department, Medicine and Health College, Lishui University, China
| | - Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Mårtensson
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Drach-Zahavy A, Broyer C, Dagan E. Similarity and accuracy of mental models formed during nursing handovers: A concept mapping approach. Int J Nurs Stud 2017; 74:24-33. [PMID: 28595111 DOI: 10.1016/j.ijnurstu.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Shared mental models are crucial for constructing mutual understanding of the patient's condition during a clinical handover. Yet, scant research, if any, has empirically explored mental models of the parties involved in a clinical handover. OBJECTIVES This study aimed to examine the similarities among mental models of incoming and outgoing nurses, and to test their accuracy by comparing them with mental models of expert nurses. DESIGN A cross-sectional study, exploring nurses' mental models via the concept mapping technique. PARTICIPANTS 40 clinical handovers. DATA COLLECTION Data were collected via concept mapping of the incoming, outgoing, and expert nurses' mental models (total of 120 concept maps). Similarity and accuracy for concepts and associations indexes were calculated to compare the different maps. RESULTS About one fifth of the concepts emerged in both outgoing and incoming nurses' concept maps (concept similarity=23%±10.6). Concept accuracy indexes were 35%±18.8 for incoming and 62%±19.6 for outgoing nurses' maps. Although incoming nurses absorbed fewer number of concepts and associations (23% and 12%, respectively), they partially closed the gap (35% and 22%, respectively) relative to expert nurses' maps. The correlations between concept similarities, and incoming as well as outgoing nurses' concept accuracy, were significant (r=0.43, p<0.01; r=0.68 p<0.01, respectively). Finally, in 90% of the maps, outgoing nurses added information concerning the processes enacted during the shift, beyond the expert nurses' gold standard. DISCUSSION AND CONCLUSIONS Two seemingly contradicting processes in the handover were identified. "Information loss", captured by the low similarity indexes among the mental models of incoming and outgoing nurses; and "information restoration", based on accuracy measures indexes among the mental models of the incoming nurses. Based on mental model theory, we propose possible explanations for these processes and derive implications for how to improve a clinical handover.
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Affiliation(s)
- Anat Drach-Zahavy
- The Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, Israel.
| | - Chaya Broyer
- The Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, Israel
| | - Efrat Dagan
- The Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, Israel
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Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative Study to Understand an Increasingly Important Type of Handoff. J Gen Intern Med 2017; 32:654-659. [PMID: 28194689 PMCID: PMC5442018 DOI: 10.1007/s11606-017-4009-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/19/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The term "holdover admissions" refers to patients admitted by an overnight physician and whose care is then transferred to a new primary team the next morning. Descriptions of the holdover process in internal medicine are sparse. OBJECTIVE To identify important factors affecting the quality of holdover handoffs at an internal medicine (IM) residency program and to compare them to previously identified factors for other handoffs. DESIGN We undertook a qualitative study using structured focus groups and interviews. We analyzed data using qualitative content analysis. PARTICIPANTS IM residents, IM program directors, and hospitalists at a large academic medical center. MAIN MEASURES A nine-question open-ended interview guide. KEY RESULTS We identified 13 factors describing holdover handoffs. Five factors-physical space, standardization, task accountability, closed-loop verification, and resilience-were similar to those described in prior handoff literature in other specialties. Eight factors were new concepts that may uniquely affect the quality of the holdover handoff in IM. These included electronic health record access, redundancy, unwritten thoughts, different clinician needs, diagnostic uncertainty, anchoring, teaching, and feedback. These factors were organized into five overarching themes: physical environment, information transfer, responsibility, clinical reasoning, and education. CONCLUSIONS The holdover handoff in IM is complex and has unique considerations for achieving high quality. Further exploration of safe, efficient, and educational holdover handoff practices is necessary.
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Lee SH, Desai SV, Phan PH. The impact of duty cycle workflow on sign-out practices: a qualitative study of an internal medicine residency program in Maryland, USA. BMJ Open 2017; 7:e015762. [PMID: 28487461 PMCID: PMC5566623 DOI: 10.1136/bmjopen-2016-015762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Although JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices. DESIGN We employed a prospective, grounded theory mixed-method design. SETTING The study was conducted at a residency programme in the mid-Atlantic USA. Two observers randomly evaluated three types of daily sign-outs for 1 week every 3 months from September 2013 to March 2014. The compliance of each observed behaviour to JCAHO's Handoff Communication Checklist was recorded. PARTICIPANTS Thirty one interns conducting 134 patient sign-outs were observed randomly among the 52 in the programme. RESULTS In the 06:00 to 07:00 sign-back, the night-cover focused on providing information on overnight events to the day interns. In the 11:00 to 12:00 sign-out, the night-cover focused on transferring task accountability to a day-cover intern before departure. In the 20:00 to 21:00 sign-out, the day interns focused on transferring responsibility of their patients to a night-cover. CONCLUSION Different sign-out periods had different emphases regarding information exchange, personal responsibility and task accountability. Sign-outs are context-specific, implying that across-the-board standardised sign-out protocols are likely to have limited efficacy and compliance. Standardisation may need to be relative to the specific type and purpose of each sign-out to be supported by interns.
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Affiliation(s)
- Soo-Hoon Lee
- Strome College of Business, Old Dominion University, Norfolk, Virginia, USA
| | - Sanjay V Desai
- Department of Medicine, Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Phillip H Phan
- Carey Business School, The Johns Hopkins University, Baltimore, Maryland, USA
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Anderson-Montoya BL, Scerbo MW, Ramirez DE, Hubbard TW. Running Memory for Clinical Handoffs: A Look at Active and Passive Processing. HUMAN FACTORS 2017; 59:393-406. [PMID: 27793979 DOI: 10.1177/0018720816672514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined. BACKGROUND Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task. METHOD Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated. RESULTS Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between. CONCLUSION Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing. APPLICATION The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.
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Affiliation(s)
| | | | - Dana E Ramirez
- Children's Hospital of the King's Daughters, Norfolk, Virginia
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Patton LJ, Tidwell JD, Falder-Saeed KL, Young VB, Lewis BD, Binder JF. Ensuring Safe Transfer of Pediatric Patients: A Quality Improvement Project to Standardize Handoff Communication. J Pediatr Nurs 2017; 34:44-52. [PMID: 28131547 DOI: 10.1016/j.pedn.2017.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND During a single hospital stay, a patient's care is transferred several times between health care clinicians requiring multiple handoffs. Nurses often voice concerns about feeling unsafe when receiving patients from other areas. AIMS The aims of the intradepartmental quality improvement project were to identify the safest way to transfer care of pediatric patients and to improve bedside nurses' knowledge on conducting an evidence based practice project. METHODS Guided by clinical nurse specialists, nurses from various departments worked together and reviewed the literature regarding safe transfers, timing, and handoff communication. RESULTS Findings from this quality improvement project led to creation and implementation of a system wide handoff tool. Use of the handoff tool decreased medication errors and improved nursing satisfaction. CONCLUSIONS Partnering with bedside nursing staff to research and apply system wide quality improvements can increase knowledge and understanding of evidence based practice as well as quality of patient care.
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Affiliation(s)
- Lindsey J Patton
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Jerithea D Tidwell
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States
| | | | - Virginia B Young
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States
| | - Brennan D Lewis
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States
| | - Jacqueline F Binder
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States
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45
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Rucker DW. Using telephony data to facilitate discovery of clinical workflows. Appl Clin Inform 2017; 8:381-395. [PMID: 28421225 PMCID: PMC6241743 DOI: 10.4338/aci-2016-11-ra-0191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Discovery of clinical workflows to target for redesign using methods such as Lean and Six Sigma is difficult. VoIP telephone call pattern analysis may complement direct observation and EMR-based tools in understanding clinical workflows at the enterprise level by allowing visualization of institutional telecommunications activity. OBJECTIVE To build an analytic framework mapping repetitive and high-volume telephone call patterns in a large medical center to their associated clinical units using an enterprise unified communications server log file and to support visualization of specific call patterns using graphical networks. METHODS Consecutive call detail records from the medical center's unified communications server were parsed to cross-correlate telephone call patterns and map associated phone numbers to a cost center dictionary. Hashed data structures were built to allow construction of edge and node files representing high volume call patterns for display with an open source graph network tool. RESULTS Summary statistics for an analysis of exactly one week's call detail records at a large academic medical center showed that 912,386 calls were placed with a total duration of 23,186 hours. Approximately half of all calling called number pairs had an average call duration under 60 seconds and of these the average call duration was 27 seconds. CONCLUSIONS Cross-correlation of phone calls identified by clinical cost center can be used to generate graphical displays of clinical enterprise communications. Many calls are short. The compact data transfers within short calls may serve as automation or re-design targets. The large absolute amount of time medical center employees were engaged in VoIP telecommunications suggests that analysis of telephone call patterns may offer additional insights into core clinical workflows.
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Affiliation(s)
- Donald W Rucker
- Donald W. Rucker, MD, 110 31st Avenue N, #406, Nashville, TN 37203, 617-834-5159, /
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46
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Rattray NA, Sico JJ, Cox LM, Russ AL, Matthias MS, Frankel RM. Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic. Jt Comm J Qual Patient Saf 2017; 43:127-137. [DOI: 10.1016/j.jcjq.2016.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Davis J, Roach C, Elliott C, Mardis M, Justice EM, Riesenberg LA. Feedback and Assessment Tools for Handoffs: A Systematic Review. J Grad Med Educ 2017; 9:18-32. [PMID: 28261391 PMCID: PMC5319625 DOI: 10.4300/jgme-d-16-00168.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident handoff communication skills are essential components of medical education training. There are no previous systematic reviews of feedback and evaluation tools for physician handoffs. OBJECTIVE We performed a systematic review of articles focused on inpatient handoff feedback or assessment tools. METHODS The authors conducted a systematic review of English-language literature published from January 1, 2008, to May 13, 2015 on handoff feedback or assessment tools used in undergraduate or graduate medical education. All articles were reviewed by 2 independent abstractors. Included articles were assessed using a quality scoring system. RESULTS A total of 26 articles with 32 tools met inclusion criteria, including 3 focused on feedback, 8 on assessment, and 15 on both feedback and assessment. All tools were used in an inpatient setting. Feedback and/or assessment improved the content or organization measures of handoff, while process and professionalism measures were less reliably improved. The Handoff Clinical Evaluation Exercise or a similar tool was used most frequently. Of included studies, 23% (6 of 26) were validity evidence studies, and 31% (8 of 26) of articles included a tool with behavioral anchors. A total of 35% (9 of 26) of studies used simulation or standardized patient encounters. CONCLUSIONS A number of feedback and assessment tools for physician handoffs in several specialties have been studied. Limited research has been done on the studied tools. These tools may assist medical educators in assessing trainees' handoff skills.
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Affiliation(s)
| | | | | | | | | | - Lee Ann Riesenberg
- Corresponding author: Lee Ann Riesenberg, PhD, RN, CMQ, University of Alabama at Birmingham, Department of Anesthesiology and Perioperative Medicine, JT 909, 619 South 19th Street, Birmingham, AL 35249-6180, 205.975.3729, fax 205.975.3552,
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Keebler JR, Lazzara EH, Patzer BS, Palmer EM, Plummer JP, Smith DC, Lew V, Fouquet S, Chan YR, Riss R. Meta-Analyses of the Effects of Standardized Handoff Protocols on Patient, Provider, and Organizational Outcomes. HUMAN FACTORS 2016; 58:1187-1205. [PMID: 27821676 DOI: 10.1177/0018720816672309] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The overall purpose was to understand the effects of handoff protocols using meta-analytic approaches. BACKGROUND Standardized protocols have been required by the Joint Commission, but meta-analytic integration of handoff protocol research has not been conducted. METHOD The primary outcomes investigated were handoff information passed during transitions of care, patient outcomes, provider outcomes, and organizational outcomes. Sources included Medline, SAGE, Embase, PsycINFO, and PubMed, searched from the earliest date available through March 30th, 2015. Initially 4,556 articles were identified, with 4,520 removed. This process left a final set of 36 articles, all which included pre-/postintervention designs implemented in live clinical/hospital settings. We also conducted a moderation analysis based on the number of items contained in each protocol to understand if the length of a protocol led to systematic changes in effect sizes of the outcome variables. RESULTS Meta-analyses were conducted on 34,527 pre- and 30,072 postintervention data points. Results indicate positive effects on all four outcomes: handoff information (g = .71, 95% confidence interval [CI] [.63, .79]), patient outcomes (g = .53, 95% CI [.41, .65]), provider outcomes (g = .51, 95% CI [.41, .60]), and organizational outcomes (g = .29, 95% CI [.23, .35]). We found protocols to be effective, but there is significant publication bias and heterogeneity in the literature. Due to publication bias, we further searched the gray literature through greylit.org and found another 347 articles, although none were relevant to this research. Our moderation analysis demonstrates that for handoff information, protocols using 12 or more items led to a significantly higher proportion of information passed compared with protocols using 11 or fewer items. Further, there were numerous negative outcomes found throughout this meta-analysis, with trends demonstrating that protocols can increase the time for handover and the rate of errors of omission. CONCLUSIONS These results demonstrate that handoff protocols tend to improve results on multiple levels, including handoff information passed and patient, provider, and organizational outcomes. These findings come with the caveat that publication bias exists in the literature on handoffs. Instances where protocols can lead to negative outcomes are also discussed. APPLICATION Significant effects were found for protocols across provider types, regardless of expertise or area of clinical focus. It also appears that more thorough protocols lead to more information being passed, especially when those protocols consist of 12 or more items. Given these findings, publication bias is an apparent feature of this literature base. Recommendations to reduce the apparent publication bias in the field include changing the way articles are screened and published.
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Affiliation(s)
- Joseph R Keebler
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Wichita State University, Kansas
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Children's Mercy Hospital, Kansas City, Missouri
| | | | - Brady S Patzer
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Wichita State University, Kansas
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Children's Mercy Hospital, Kansas City, Missouri
| | - Evan M Palmer
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Wichita State University, Kansas
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Children's Mercy Hospital, Kansas City, Missouri
| | - John P Plummer
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Wichita State University, Kansas
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Children's Mercy Hospital, Kansas City, Missouri
| | | | - Victoria Lew
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Sarah Fouquet
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Wichita State University, Kansas
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Children's Mercy Hospital, Kansas City, Missouri
| | - Y Raymond Chan
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Wichita State University, Kansas
- Embry-Riddle Aeronautical University, Daytona Beach, Florida
- Children's Mercy Hospital, Kansas City, Missouri
| | - Robert Riss
- Children's Mercy Hospital, Kansas City, Missouri
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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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Alhamid SM, Lee DXY, Wong HM, Chuah MB, Wong YJ, Narasimhalu K, Tan TT, Low SY. Implementing electronic handover: interventions to improve efficiency, safety and sustainability. Int J Qual Health Care 2016; 28:608-614. [PMID: 27512129 DOI: 10.1093/intqhc/mzw082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 06/12/2016] [Accepted: 06/15/2016] [Indexed: 02/05/2023] Open
Abstract
PROBLEM Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). INITIAL ASSESSMENT There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. SOLUTION A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. IMPLEMENTATION Innovative solutions using media and online software provided cost-efficient measures to improve compliance. EVALUATION The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. LESSONS LEARNT An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability.
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Affiliation(s)
- Sharifah Munirah Alhamid
- Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Desmond Xue-Yuan Lee
- Clinical Services and Improvement, Division of Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Hei Man Wong
- Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Matthew Bingfeng Chuah
- Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Yu Jun Wong
- Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Kaavya Narasimhalu
- Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Su Ying Low
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
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