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Johnson NL, Moeckli J. Conceptualizations of interprofessional communication in intensive care units: findings from a scoping review. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:130-142. [PMID: 38197399 DOI: 10.1080/17538068.2023.2297124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Clinical errors in intensive care units (ICUs) are consistently attributed to communication errors. Despite its importance for patient safety and quality in critical care settings, few studies consider interprofessional communication as more than the basic exchange of information. METHODS We conducted a scoping review of interprofessional communication in ICUs to (1) characterize how communication is defined and measured and (2) identify contributions the field of health communication can make to team communication in ICUs. Through a series of queries in PubMed and Communication and Mass Media Complete databases, we identified and compared persistent gaps in how communication is framed and theorized in 28 publications from health services and 6 from social science outlets. We identified research priorities and suggested strategies for discussing communication more holistically in future health services research. RESULTS 34 articles published from 1999 to 2021 were included. Six explicitly defined communication. Six were published in social science journals, but none were authored by a communication studies scholar. Half of the articles addressed communication as a transaction focused on information transfer, and the other half addressed communication as a process. CONCLUSIONS Methodological implications are identified with the intent to encourage future interdisciplinary collaboration for studying communication in ICUs. We discuss the importance of (1) using language to describe communication that facilitates interdisciplinary engagement, (2) prioritizing communication as a process and using qualitative methods to provide insight, and (3) engaging health communication theories and experts to assist in developing more fruitful research questions and designs.
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Affiliation(s)
- Nicole L Johnson
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jane Moeckli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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Bonaconsa C, Mbamalu O, Surendran S, George A, Mendelson M, Charani E. Optimizing infection control and antimicrobial stewardship bedside discussion: a scoping review of existing evidence on effective healthcare communication in hospitals. Clin Microbiol Infect 2024; 30:336-352. [PMID: 38101471 DOI: 10.1016/j.cmi.2023.12.011] [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: 08/14/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The link between healthcare worker (HCW) communication, teamwork and patient safety is well-established. Infection prevention and control (IPC) and antimicrobial stewardship (AMS) require multidisciplinary teamwork and communication. OBJECTIVES We conducted a scoping review of published evidence on effective mechanisms of HCW team communication in hospitals with the intention of transferring and tailoring learning to IPC and AMS team communication. METHODS PubMed, Scopus, Web of Science, and CINAHL were searched for studies that investigated HCW team communication across in-hospital patient pathways. Studies published between 2000 and 2021 that provided evidence on/or described the effect of communication on team and patient outcomes in hospital were included. Through a process of inductive qualitative content analysis, key themes in the included studies were identified. RESULTS Of 537 studies identified, 53 (from high-income countries) were included in the data extraction. Fifty one percent (27/53) of studies were conducted in high acuity settings e.g., intensive care units. Standardizing or structuring the content and/or process of team communication was the most common goal of interventions (34/53, 64%). The key outcome measures were either team communication focused (25/34,74%) or patient and process outcome focused (8/34, 24%), such as reduced length of mechanical ventilation days, length of hospital stay, and shorter empiric antibiotic duration. Four studies (4/53, 8%) associated improved communication with positive IPC and AMS outcome measures. Mixed method intervention studies primarily facilitated collaborative input from HCWs and applied structures to standardize the content of patient care discussions, whereas observational studies describe component of team communication. CONCLUSIONS A communication strategy that formalizes input from multidisciplinary team members can lead to optimized and consistent clinical discussion including in IPC and AMS-related care. Although we were unable to assess the effectiveness of interventions, the existing evidence suggests that optimizing team communication can have a positive effect on infection-related patient outcomes.
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Affiliation(s)
- Candice Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Oluchi Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Surya Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India; Department of Health Systems and Equity, The George Institute for Global Health, Hyderabad, India
| | - Anu George
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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Merriman C, Freeth D. Conducting a good ward round: How do leaders do it? J Eval Clin Pract 2022; 28:411-420. [PMID: 35220643 PMCID: PMC9305892 DOI: 10.1111/jep.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. METHOD Mixed-method appreciative inquiry (AI) into how WRs go well and could go well more often. CONTEXT daily interprofessional consultant-led WRs in a large adult critical care unit. DATA ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. PARTICIPANTS 256 qualified healthcare professionals working in the unit. RESULTS Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. CONCLUSIONS Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings.
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Affiliation(s)
- Clair Merriman
- Insitute of Health Sciences Education, Queen Mary University of London, London, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Della Freeth
- Insitute of Health Sciences Education, Queen Mary University of London, London, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Education Directorate, Royal College of Physicians, London, UK
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Park J, Zhong X, Dong Y, Barwise A, Pickering BW. Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach. BMC Anesthesiol 2022; 22:10. [PMID: 34983402 PMCID: PMC8724599 DOI: 10.1186/s12871-021-01548-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Background ICU operational conditions may contribute to cognitive overload and negatively impact on clinical decision making. We aimed to develop a quantitative model to investigate the association between the operational conditions and the quantity of medication orders as a measurable indicator of the multidisciplinary care team’s cognitive capacity. Methods The temporal data of patients at one medical ICU (MICU) of Mayo Clinic in Rochester, MN between February 2016 to March 2018 was used. This dataset includes a total of 4822 unique patients admitted to the MICU and a total of 6240 MICU admissions. Guided by the Systems Engineering Initiative for Patient Safety model, quantifiable measures attainable from electronic medical records were identified and a conceptual framework of distributed cognition in ICU was developed. Univariate piecewise Poisson regression models were built to investigate the relationship between system-level workload indicators, including patient census and patient characteristics (severity of illness, new admission, and mortality risk) and the quantity of medication orders, as the output of the care team’s decision making. Results Comparing the coefficients of different line segments obtained from the regression models using a generalized F-test, we identified that, when the ICU was more than 50% occupied (patient census > 18), the number of medication orders per patient per hour was significantly reduced (average = 0.74; standard deviation (SD) = 0.56 vs. average = 0.65; SD = 0.48; p < 0.001). The reduction was more pronounced (average = 0.81; SD = 0.59 vs. average = 0.63; SD = 0.47; p < 0.001), and the breakpoint shifted to a lower patient census (16 patients) when at a higher presence of severely-ill patients requiring invasive mechanical ventilation during their stay, which might be encountered in an ICU treating patients with COVID-19. Conclusions Our model suggests that ICU operational factors, such as admission rates and patient severity of illness may impact the critical care team’s cognitive function and result in changes in the production of medication orders. The results of this analysis heighten the importance of increasing situational awareness of the care team to detect and react to changing circumstances in the ICU that may contribute to cognitive overload. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01548-7.
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Affiliation(s)
- Jaeyoung Park
- Department of Industrial and Systems Engineering, University of Florida, 482 Weil Hall, P.O. Box 116595, Gainesville, FL, 32611-6595, USA
| | - Xiang Zhong
- Department of Industrial and Systems Engineering, University of Florida, 482 Weil Hall, P.O. Box 116595, Gainesville, FL, 32611-6595, USA.
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Shivananda S, Osiovich H, de Salaberry J, Hait V, Gautham KS. Improving Efficiency of Multidisciplinary Bedside Rounds in the NICU: A Single Centre QI Project. Pediatr Qual Saf 2022; 7:e511. [PMID: 35071954 PMCID: PMC8782118 DOI: 10.1097/pq9.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 08/18/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Inconsistent workflow, communication, and role clarity generate inefficiencies during bedside rounds in a neonatal intensive care unit. These inefficiencies compromise the time needed for essential activities and result in reduced staff and family satisfaction. This study’s primary aim was to reduce the mean duration of bedside rounds by 25% within 3 months by redesigning the rounding processes and applying QI principles. The secondary aims were to improve staff and family experience. Methods: We conducted this work in an academic 50-bed neonatal intensive care unit involving 350 staff members. The change interventions included: (i) reinforcing essential value-added activities like standardizing rounding time, the sequencing of patients rounded, sequencing each team member rounding presentations, team preparation, bedside presentation content, and time management; (ii) reducing non-value-added activities; and (iii) moving value-added nonessential activities outside of the rounds. Results: The mean duration of rounds decreased from 229 minutes in the pre-implementation to 132 minutes in the postimplementation phase. The proportion of staff showing satisfaction regarding various components of the rounds increased from 5% to 60%, and perceived staff involvement during the rounds increased from 70% to 77%. Ninety-three percent of family experience survey respondents expressed satisfaction at being invited for bedside reporting and being involved in decision-making or care planning. The staff did not report any adverse events related to the new rounds process. Conclusion: Redesigning bedside rounds improved staff engagement and workflow, resulting in efficient rounds and better staff experience.
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Chapman LB, Kopp KE, Petty MG, Hartwig JLA, Pendleton KM, Langer K, Meiers SJ. Benefits of collaborative patient care rounds in the intensive care unit. Intensive Crit Care Nurs 2020; 63:102974. [PMID: 33262010 DOI: 10.1016/j.iccn.2020.102974] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Improving care of critically ill patients requires using an interprofessional care model and care standardisation. OBJECTIVES Determine whether collaborative patient care rounds in the intensive care unit increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration. METHODS Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration. RESULTS Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001). CONCLUSION This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.
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Affiliation(s)
- Leah B Chapman
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States; University of Minnesota Medical Center, Minneapolis, MN, United States.
| | - Kathleen E Kopp
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States; University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Michael G Petty
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Jodi L A Hartwig
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Kathryn M Pendleton
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kimberly Langer
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States
| | - Sonia J Meiers
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States
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7
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Martí JD, McWilliams D, Gimeno-Santos E. Physical Therapy and Rehabilitation in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit. Semin Respir Crit Care Med 2020; 41:886-898. [PMID: 32725615 DOI: 10.1055/s-0040-1709139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that affects a person's ability to exercise and undertake normal physical function due to breathlessness, poor physical fitness, and muscle fatigue. Patients with COPD often experience exacerbations due to pulmonary infections, which result in worsening of their symptoms, more loss of function, and often require hospital treatment or in severe cases admission to intensive care units. Recovery from such exacerbations is often slow, and some patients never fully return to their previous level of activity. This can lead to permanent disability and premature death.Physical therapists play a key role in the respiratory management and rehabilitation of patients admitted to intensive care following acute exacerbation of COPD. This article discusses the key considerations for respiratory management of patients requiring invasive mechanical ventilation, providing an evidence-based summary of commonly used interventions. It will also explore the evidence to support the introduction of early and structured programs of rehabilitation to support recovery in both the short and the long term, as well as active mobilization, which includes strategies to minimize or prevent physical loss through early retraining of both peripheral and respiratory muscles.
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Affiliation(s)
- Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Unit, Hospital Clínic de Barcelona, Spain
| | - David McWilliams
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - Elena Gimeno-Santos
- Respiratory Department, Hospital Clinic de Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Rikos N, Linardakis M, Economou C, Rovithis M, Philalithis A. The nurses' own views about the inter-shift handover process. Contemp Nurse 2019; 55:83-94. [PMID: 30975066 DOI: 10.1080/10376178.2019.1606723] [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] [Indexed: 10/27/2022]
Abstract
Background: Nursing handovers provide critical information on the patient, requiring special communication skills and techniques between the nurses' shift-change. Aim: Current study investigates the experiences/views of nurses regarding the handover process. Methods: An observation method was applied assesing 22 interviews using a semi-structured questionnaire and an audio recording system throughout mixed content analysis. Results: Nursing handover mainly involves medical instructions, detailed records of each patient's general condition or drug administration guidelines. Nurses determined which pieces of information were significant to transfer to the next shift were the medical instructions, the patient's hemodynamic condition and the care plans implemented by the previous nurse. The information was mainly drawn from events occurring in the previous 24 h, from the medical instructions, or the doctors and the nursing outcomes, and to a lesser extent from the events of the previous shifts and the nursing folders. None of the participants had received, as they stated, any training in the handover process. Conclusions: It is highlighting the importance of organized, standardized and up-to-date handovers, and the fundamental part they play in the health care system.
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Affiliation(s)
- Nikos Rikos
- a Department of Nursing, School of Health and Welfare Services , Technological Educational Institute (TEI) of Crete , Heraklion , Greece.,b Department of Social Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece
| | - Manolis Linardakis
- b Department of Social Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece
| | - Charalampos Economou
- c Department of Sociology, School of Social Sciences , Panteion University of Social and Political Sciences , Athens , Greece
| | - Michael Rovithis
- a Department of Nursing, School of Health and Welfare Services , Technological Educational Institute (TEI) of Crete , Heraklion , Greece
| | - Anastas Philalithis
- b Department of Social Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece
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Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings. Appl Nurs Res 2018; 40:80-89. [DOI: 10.1016/j.apnr.2017.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/21/2017] [Accepted: 12/14/2017] [Indexed: 11/20/2022]
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Spooner AJ, Aitken LM, Chaboyer W. Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey. Aust Crit Care 2017; 31:278-283. [PMID: 29153960 DOI: 10.1016/j.aucc.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. OBJECTIVES The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. METHODS The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. RESULTS AND DISCUSSION A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. CONCLUSION Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover.
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Affiliation(s)
- Amy J Spooner
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.
| | - Leanne M Aitken
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia; School of Health Sciences, City University London, London, United Kingdom
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Takiguchi C, Yatomi Y, Inoue T. Development of the Nurses' Care Coordination Competency Scale for mechanically ventilated patients in critical care settings in Japan: Part 2 Validation of the scale. Intensive Crit Care Nurs 2017; 43:30-38. [PMID: 28911833 DOI: 10.1016/j.iccn.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/26/2017] [Accepted: 08/05/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To confirm the validity and reliability of the nurses' care coordination competency draft scale for mechanically ventilated patients in Japan. DESIGN/METHOD In this cross sectional observational study, a draft scale measuring care coordination was distributed to 2189 nurses from 73 intensive care units in Japan from February-March 2016. Based on the valid 887 responses, we examined construct validity including structural validity (exploratory and confirmatory factor analysis), convergent and discriminant validity and internal consistency reliability. SETTINGS 73 Intensive care units. RESULTS Exploratory factor analyses yielded four factors with 22 items: 1) promoting team cohesion, 2) understanding care coordination needs, 3) aggregating and disseminating information, 4) devising and clearly articulating the care vision. The four-factor model was confirmed using a confirmatory factor analysis (confirmatory fit index=0.942, root mean square error of approximation=0.062). Scale scores positively correlated with team leadership and clearly identified and discriminated nurses' attributes. Cronbach's alpha coefficient for each subscale was between 0.812 and 0.890, and 0.947 for the total scale. CONCLUSIONS The Nurses' Care Coordination Competency Scale with four factors and 22 items had sufficient validity and reliability. The scale could make care coordination visible in nursing practice. Future research on the relationship between this scale and patient outcomes is needed.
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Affiliation(s)
- Chie Takiguchi
- Toho University, Miyama 2-2-1, Funabashi, Chiba 274-8510, Japan
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Valdez RS, McGuire KM, Rivera AJ. Qualitative ergonomics/human factors research in health care: Current state and future directions. APPLIED ERGONOMICS 2017; 62:43-71. [PMID: 28411739 DOI: 10.1016/j.apergo.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 06/07/2023]
Abstract
The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care.
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Affiliation(s)
- Rupa Sheth Valdez
- Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908, USA.
| | - Kerry Margaret McGuire
- Habitability and Human Factors Branch, NASA's Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
| | - A Joy Rivera
- Knowledge and Systems Architect Team, Information Management Services, Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave., Milwaukee, WI 53226, USA.
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Spooner AJ, Aitken LM, Corley A, Fraser JF, Chaboyer W. Nursing team leader handover in the intensive care unit contains diverse and inconsistent content: An observational study. Int J Nurs Stud 2016; 61:165-72. [PMID: 27359100 DOI: 10.1016/j.ijnurstu.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 05/06/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. OBJECTIVE The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover. DESIGN A prospective observational study. SETTING A 21-bed medical/surgical adult intensive care unit specialising in cardiothoracic surgery at a tertiary referral hospital in Queensland, Australia. PARTICIPANTS Senior nurses (Grade 5 and 6 Registered nurses) working in team leader roles, employed in the intensive care unit were sampled. METHOD After obtaining consent from nursing staff, team leader handovers were audiotaped over 20 days. Audio recordings were transcribed and analysed using deductive and inductive content analysis. The frequency of content discussed at handover that fell within the a priori categories of the ISBAR schema (Identify-Situation-Background-Assessment-Recommendation) was calculated. RESULTS Forty nursing team leader handovers were recorded resulting in 277 patient handovers and a median of 7 (IQR 2) patients discussed at each handover. The majority of nurses discussed the Identity (99%), Situation (96%) and Background (88%) of the patient, however Assessment (69%) content was varied and patient Recommendations (60%) were discussed less frequently. A diverse range of additional information was discussed that did not fit into the ISBAR schema. CONCLUSIONS Despite universal acknowledgement of the importance of nursing team leader handover, there are no previous studies assessing its content. Study findings indicate that nursing team leader handovers contain diverse and inconsistent content, which could lead to inadequate handovers that compromise patient safety. Further work is required to develop structured handover processes for nursing team leader handovers.
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Affiliation(s)
- A J Spooner
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane 4032, Australia; School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan Campus, Brisbane 4111, Australia.
| | - L M Aitken
- School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan Campus, Brisbane 4111, Australia; NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith University, Menzies Health Institute, Gold Coast 4222, Australia; Intensive Care Unit, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Brisbane 4102, Australia
| | - A Corley
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane 4032, Australia
| | - J F Fraser
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane 4032, Australia
| | - W Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith University, Menzies Health Institute, Gold Coast 4222, Australia
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Van den Bulcke B, Vyt A, Vanheule S, Hoste E, Decruyenaere J, Benoit D. The perceived quality of interprofessional teamwork in an intensive care unit: A single centre intervention study. J Interprof Care 2016; 30:301-8. [DOI: 10.3109/13561820.2016.1146876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A Survey of Rounding Practices in Canadian Adult Intensive Care Units. PLoS One 2015; 10:e0145408. [PMID: 26700860 PMCID: PMC4689549 DOI: 10.1371/journal.pone.0145408] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement. DESIGN Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7). MEASUREMENTS AND MAIN RESULTS Medical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient's bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥ 1 interruption for ≥ 50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning. CONCLUSIONS There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.
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Miller A, Wagner CE, Song Y, Burns K, Ahmad R, Lee Parmley C, Weinger MB. Implementing Goal-Directed Protocols Reduces Length of Stay After Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:441-7. [DOI: 10.1053/j.jvca.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Indexed: 11/11/2022]
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Collins S, Hurley AC, Chang FY, Illa AR, Benoit A, Laperle S, Dykes PC. Content and functional specifications for a standards-based multidisciplinary rounding tool to maintain continuity across acute and critical care. J Am Med Inform Assoc 2013; 21:438-47. [PMID: 24081019 DOI: 10.1136/amiajnl-2013-001949] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Maintaining continuity of care (CoC) in the inpatient setting is dependent on aligning goals and tasks with the plan of care (POC) during multidisciplinary rounds (MDRs). A number of locally developed rounding tools exist, yet there is a lack of standard content and functional specifications for electronic tools to support MDRs within and across settings. OBJECTIVE To identify content and functional requirements for an MDR tool to support CoC. MATERIALS AND METHODS We collected discrete clinical data elements (CDEs) discussed during rounds for 128 acute and critical care patients. To capture CDEs, we developed and validated an iPad-based observational tool based on informatics CoC standards. We observed 19 days of rounds and conducted eight group and individual interviews. Descriptive and bivariate statistics and network visualization were conducted to understand associations between CDEs discussed during rounds with a particular focus on the POC. Qualitative data were thematically analyzed. All analyses were triangulated. RESULTS We identified the need for universal and configurable MDR tool views across settings and users and the provision of messaging capability. Eleven empirically derived universal CDEs were identified, including four POC CDEs: problems, plan, goals, and short-term concerns. Configurable POC CDEs were: rationale, tasks/'to dos', pending results and procedures, discharge planning, patient preferences, need for urgent review, prognosis, and advice/guidance. DISCUSSION Some requirements differed between settings; yet, there was overlap between POC CDEs. CONCLUSIONS We recommend an initial list of 11 universal CDEs for continuity in MDRs across settings and 27 CDEs that can be configured to meet setting-specific needs.
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Affiliation(s)
- Sarah Collins
- Clinical Informatics Partners eCare, Partners Healthcare, Wellesley, Massachusetts, USA
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Abstract
OBJECTIVES Patient care rounds are a key mechanism by which healthcare providers communicate and make patient care decisions in the ICU but no synthesis of best practices for rounds currently exists. Therefore, we systematically reviewed the evidence for facilitators and barriers to patient care rounds in the ICU. DATA SOURCES Search of Medline, Embase, CINAHL, PubMed, and the Cochrane library through September 21, 2012. STUDY SELECTION Original, peer-reviewed research studies (no methodological restrictions) were selected, which described current practices, facilitators, or barriers to healthcare provider rounding in the ICU. DATA EXTRACTION Two authors with methodological and content expertise independently abstracted data using a prespecified abstraction tool. DATA SYNTHESIS The literature search identified 7,373 citations. Reviews of abstracts led to the retrieval of 136 full text articles for assessment; 43 articles in three languages (English, German, Spanish) were selected for review. Of these, 13 were ethnographic studies and 15 uncontrolled before-after studies. Six studies used control groups, including one cross-over randomized, one time-series, three cohort, and one controlled before-after study. A total of 13 facilitators and 9 barriers to patient care rounds were identified through a narrative and meta-synthesis of included studies. Identified facilitators suggest that the quality of rounds is improved when conducted by a multidisciplinary group of providers, with explicitly defined roles, using a standardized structure and goal-oriented approach that includes a best practices checklist. Barriers to quality patient care rounds include poor information retrieval and documentation, interruptions, long rounding times, and allied healthcare provider perceptions of not being valued by rounding physicians. CONCLUSIONS Although the evidence base for best practices of patient care rounds in the ICU is limited, several practical and low-risk practices can be considered for implementation.
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Abstract
The purpose of this chapter on human factors in critical care medical environments is to provide a systematic review of the human factors and ergonomics contributions that led to significant improvements in patient safety over the last five decades. The review will focus on issues that contributed to patient injury and fatalities and how human factors and ergonomics can improve performance of providers in critical care. Given the complexity of critical care delivery, a review needs to cover a wide range of subjects. In this review, I take a sociotechnical systems perspective on critical care and discuss the people, their technical and nontechnical skills, the importance of teamwork, technology, and ergonomics in this complex environment. After a description of the importance of a safety climate, the chapter will conclude with a summary on how human factors and ergonomics can improve quality in critical care delivery.
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Human factors in critical care: towards standardized integrated human-centred systems of work. Curr Opin Crit Care 2013; 16:618-22. [PMID: 20736826 DOI: 10.1097/mcc.0b013e32833e9b4b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Improvements in safety and quality benefit from a systems approach. Human factors is the study and practice of the relationship between humans and systems. This review examines recent advances in human factors in healthcare. RECENT FINDINGS Early studies focused on understanding incidents, and on the translation of principles from aviation to healthcare, which demonstrated a useful but limited application of the human factors approach. More recent studies have begun to address the complexity of the relationship between human behaviour and technology, tasks, environment and organization. Human factors frameworks have been usefully applied that aid in these complex considerations, providing a better understanding of the healthcare system, and a much broader range of solutions to problems than checklists, protocols or training. In particular, in improving equipment design and procurement; improving job design by understanding the demands and tasks of individual healthcare practitioners; in improving what and when training is delivered; and the integration of these complex system components into a coherent whole. SUMMARY The human factors approach is not yet mature in healthcare, but the importance is being increasingly recognized, and the breadth of application continually expanded.
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Abstract
PURPOSE OF REVIEW It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. RECENT FINDINGS Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. SUMMARY Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.
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Have ECT, Tulleken JE. Leadership training and quality improvement of interdisciplinary rounds in the ICU. Crit Care 2013. [PMCID: PMC3643040 DOI: 10.1186/cc12460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ten Have ECM, Hagedoorn M, Holman ND, Nap RE, Sanderman R, Tulleken JE. Assessing the quality of interdisciplinary rounds in the intensive care unit. J Crit Care 2013; 28:476-82. [PMID: 23428713 DOI: 10.1016/j.jcrc.2012.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/10/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs. MATERIALS AND METHODS Delphi rounds were done to analyze videotaped patient presentations and elaborated together with previous literature search. The IDR Assessment Scale was developed, statistically tested, and applied to 98 videotaped patient presentations during 22 IDRs in 3 ICUs for adults in 2 hospitals in Groningen, The Netherlands. RESULTS The IDR Assessment Scale had 19 quality indicators, subdivided in 2 domains: "patient plan of care" and "process." Indicators were "essential" or "supportive." The interrater reliability of 9 videotaped patient presentations among at least 3 raters was satisfactory (κ = 0.85). The overall item score correlations between 3 raters were excellent (r = 0.80-0.94). Internal consistency in 98 videotaped patient presentations was acceptable (α = .78). Application to IDRs demonstrated that indicators could be unambiguously rated. CONCLUSIONS The quality of IDRs in the ICU can be reliably assessed for patient plan of care and process with the IDR Assessment Scale.
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Affiliation(s)
- Elsbeth C M Ten Have
- Directorate Medical Affairs, Quality and Safety, University Medical Center Groningen, Groningen, The Netherlands.
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Manser T, Foster S, Flin R, Patey R. Team communication during patient handover from the operating room: more than facts and figures. HUMAN FACTORS 2013; 55:138-156. [PMID: 23516799 DOI: 10.1177/0018720812451594] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study was aimed at examining team communication during postoperative handover and its relationship to clinicians' self-ratings of handover quality. BACKGROUND Adverse events can often be traced back to inadequate communication during patient handover. Research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. METHOD We conducted a prospective, cross-sectional observation study using a taxonomy for handover behaviors developed on the basis of established approaches for analyzing teamwork in health care. Immediately after the observation, transferring and receiving clinicians rated the quality of the handover using a structured tool for handover quality assessment. Handover communication during 117 handovers in three postoperative settings and its relationship to clinicians' self-ratings of handover quality were analyzed with the use of correlation analyses and analyses of variance. RESULTS We identified significantly different patterns of handover communication between clinical settings and across handover roles. Assessments provided during handover were related to higher ratings of handover quality overall and to all four dimensions of handover quality identified in this study. If assessment was lacking, we observed compensatory information seeking by the receiving team. CONCLUSION Handover quality is more than the correct, complete transmission of patient information. Assessments, including predictions or anticipated problems, are critical to the quality of postoperative handover. APPLICATION The identification of communication behaviors related to high-quality handovers is necessary to effectively support the design and evaluation of handover improvement efforts.
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Affiliation(s)
- Tanja Manser
- University of Fribourg, Rue P.-A. de Faucigny 2, CH-1700 Fribourg, Switzerland.
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The Changing Nature of ICU Charge Nurses’ Decision Making: From Supervision of Care Delivery to Unit Resource Management. Jt Comm J Qual Patient Saf 2013; 39:38-47. [DOI: 10.1016/s1553-7250(13)39007-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bridging gaps in handoffs: A continuity of care based approach. J Biomed Inform 2012; 45:240-54. [DOI: 10.1016/j.jbi.2011.10.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/29/2011] [Accepted: 10/30/2011] [Indexed: 11/17/2022]
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Abstract
The benefits of interdisciplinary approaches in patient care, research and education are quite obvious and set the trend for more interdisciplinary structures. In order to achieve sustained success, however, there are numerous risks of interdisciplinary collaboration that have to be considered. Interdisciplinarity leads to an increasing degree of specialization and consequently to a greater experience of specialists in highly specific procedures. Nevertheless, this is accompanied by a loss of experience of those who do not perform these procedures anymore. Not least, due to the high specialization, the surgeon's profession is changing from generalist to specialist. Hence, the education of young physicians, students and researchers has to be adapted to this reality. It remains unanswered if these changes contribute to the decline in the number of applicants in surgery. In conclusion, the risks of the contradictory contexts of interdisciplinarity can be counteracted with simple principles of fair and cooperative partnership.
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28
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Doyle KE, Cruickshank M. Stereotyping stigma: undergraduate health students' perceptions at handover. J Nurs Educ 2012; 51:255-61. [PMID: 22390377 DOI: 10.3928/01484834-20120309-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 01/25/2012] [Indexed: 11/20/2022]
Abstract
The World Health Organization (WHO) has recognized that errors in communication are one of the leading causes of adverse patient outcomes. Consequently, the WHO developed the High 5s Project to review, among other variables, handover of patients between shifts, professionals, and organizations. Seven countries were involved in the initial project. Australia responded by using the ISOBAR (Identify, Situation, Observations, Background, Agreed plan, and Read-back) tool as a template. However, none of the countries involved considered the social and emotional effects of handover on the staff or patients, although research has demonstrated that attitudes and values can be handed over from one nurse to another during this process. This article shows how the nurse who hands over care from one shift to the next can transfer stigma and labeling and offers suggestions for nurse educators and clinicians to apply national standards and core values to clinical practice and education.
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Ilan R, LeBaron CD, Christianson MK, Heyland DK, Day A, Cohen MD. Handover patterns: an observational study of critical care physicians. BMC Health Serv Res 2012; 12:11. [PMID: 22233877 PMCID: PMC3280171 DOI: 10.1186/1472-6963-12-11] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 01/10/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Handover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication. METHODS Prospective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations); SOAP (Subjective, Objective, Assessment, Plan); and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics. RESULTS Mean (± standard deviation) duration of patient-specific handovers was 2 min 58 sec (± 57 sec). The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9%) of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0) times in patient handovers; they followed Objective blocks in only 45.9% of the opportunities and preceded Plan in just 21.8%. Certain communication elements were occasionally absent. For example, SBAR's Recommendation and admission note information about the patient's Past Medical History were absent from 22 (55.0%) and 20 (50.0%), respectively, of patient handovers. CONCLUSIONS Clinical handover practice of faculty-level critical care physicians did not conform to any of the three predefined structuring schemes. Further research is needed to examine whether alternative approaches to handover communication can be identified and to identify features of high-quality handover communication.
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Affiliation(s)
- Roy Ilan
- Department of Medicine and Critical Care Program, Queen's University, Kingston General Hospital, Etherington Hall, Room 1005, 94 Stuart Street, Kingston, ON, Canada, K7L 3N6
| | - Curtis D LeBaron
- Department of Organizational Leadership & Strategy, Marriott School of Management, Tanner Building 790, Brigham Young University, Provo, Utah 84602, USA
| | | | - Daren K Heyland
- Department of Medicine and Critical Care Program, Queen's University, Kingston General Hospital, Etherington Hall, Room 1005, 94 Stuart Street, Kingston, ON, Canada, K7L 3N6
| | - Andrew Day
- Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada, K7L 3N6
| | - Michael D Cohen
- School of Information, 312 West Hall, School of Public Policy, 407 Lorch Hall, University of Michigan, Ann Arbor, Michigan 48109-1092, USA
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Collins SA, Stein DM, Vawdrey DK, Stetson PD, Bakken S. Content overlap in nurse and physician handoff artifacts and the potential role of electronic health records: a systematic review. J Biomed Inform 2011; 44:704-12. [PMID: 21295158 DOI: 10.1016/j.jbi.2011.01.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/30/2010] [Accepted: 01/27/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The aims of this systematic review were: (1) to analyze the content overlap between nurse and physician hospital-based handoff documentation for the purpose of developing a list of interdisciplinary handoff information for use in the future development of shared and tailored computer-based handoff tools, and (2) to evaluate the utility of the Continuity of Care Document (CCD) standard as a framework for organizing hospital-based handoff information for use in electronic health records (EHRs). METHODS We searched PubMed for studies published through July 2010 containing the indexed terms: handoff(s), hand-off, handover(s), shift-report, shift report, signout, and sign-out. Original, hospital-based studies of acute care nursing or physician handoff were included. Handoff information content was organized into lists of nursing, physician, and interdisciplinary handoff information elements. These information element lists were organized using CCD sections, with additional sections being added as needed. RESULTS Analysis of 36 studies resulted in a total of 95 handoff information elements. Forty-six percent (44/95) of the information overlapped between the nurse and physician handoff lists. Thirty-six percent (34/95) were specific to the nursing list and 18% (17/95) were specific to the physician list. The CCD standard was useful for categorizing 80% of the terms in the lists and 12 category names were developed for the remaining 20%. CONCLUSION Standardized interdisciplinary, nursing-specific, and physician-specific handoff information elements that are organized around the CCD standard and incorporated into EHRs in a structured narrative format may increase the consistency of data shared across all handoffs, facilitate the establishment of common ground, and increase interdisciplinary communication.
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Affiliation(s)
- Sarah A Collins
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA.
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Collins SA, Bakken S, Vawdrey DK, Coiera E, Currie LM. Agreement between common goals discussed and documented in the ICU. J Am Med Inform Assoc 2010; 18:45-50. [PMID: 21113075 DOI: 10.1136/jamia.2010.006437] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Meaningful use of electronic health records (EHRs) is dependent on accurate clinical documentation. Documenting common goals in the intensive care unit (ICU), such as sedation and ventilator management plans, may increase collaboration and decrease patient length of stay. This study analyzed the degree to which goals stated were present in the EHR. DESIGN Descriptive correlational study of common goals verbally stated during daily ICU interdisciplinary rounds compared with the presence of those goals, and actions related to those goals, documented in the EHR over the subsequent 24 h for 28 patients over 15 days. The study setting was a neurovascular ICU with a fully implemented electronic nursing and physician documentation system. MEASUREMENTS Descriptive statistics and χ(2) analyses were used to assess differences in EHR documentation of stated goals and goal-related actions. Inter-coder reliability was performed on 16 (13%) of the 127 stated goals. RESULTS One-quarter of the stated goals were not documented in the EHR. If a goal was not documented, actions related to that goal were 60% less likely to be documented. The attending physician note contained 81% of the stated ventilator weaning goals, but only 49% of the sedation weaning goals; additionally, sedation goals were not part of the structured nursing documentation. Inter-coder reliability (κ) was greater than 0.82. LIMITATIONS Observations in a single ICU setting at a large academic medical center using a commercial EHR. CONCLUSION The current documentation tools available in EHRs may not be sufficient to capture common goals of ICU patient care.
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Affiliation(s)
- Sarah A Collins
- Department of Biomedical Informatics, Columbia University, New York, New York, USA.
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Patterson ES, Wears RL. Patient handoffs: standardized and reliable measurement tools remain elusive. Jt Comm J Qual Patient Saf 2010; 36:52-61. [PMID: 20180437 DOI: 10.1016/s1553-7250(10)36011-9] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous quality improvement projects on patient handoffs have been conducted, yet standardized, reliable measurement tools remain elusive. HANDOFF QUALITY MEASURES CLASSIFIED BY PRIMARY HANDOFF PURPOSE The literature review, which yielded approximately 400 relevant articles, led to the identification of seven primary functions for patient handoffs, each of which implies different interventions to improve them: (1) Framing 1, information processing is the most prevalent in the patient handoff literature; (2) Framing 2, stereotypical narratives, emphasizes highlighting deviations from typical narratives, such as a patient who is allergic to the preferred antibiotic for treating his or her diagnosed condition; (3) Framing 3, resilience, takes advantage of the transparency of the thought processes revealed through the conversation to identify erroneous assumptions and actions; (4) Framing 4, accountability, emphasizes the transfer of responsibility and authority; (5) Framing 5, social interaction, considers the perspective of the participants in the exchange; (6) Framing 6, distributed cognition, addresses how a transfer to a new care provider affects a network of specialized practitioners performing dedicated roles who may or may not be transitioning at the same time; (7) Framing 7, cultural norms, relates to how group values (instantiated as social norms for acceptable behavior) in an organization or suborganization are negotiated and maintained over time. DISCUSSION The diversity of handoff measurement approaches suggests a lack of consensus about the primary purpose of a handoff, as well as about what interventions are most promising for improving handoff processes. Recognizing that there are simultaneously multiple purposes for handoffs is a critical precursor to quality improvement.
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Affiliation(s)
- Emily S Patterson
- Health Information Management and Systems Division, Ohio State University Medical Center, School of Allied Medical Professions, Columbus, Ohio, USA.
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Miller A, Weinger MB, Buerhaus P, Dietrich MS. Care coordination in intensive care units: communicating across information spaces. HUMAN FACTORS 2010; 52:147-161. [PMID: 20942247 DOI: 10.1177/0018720810369149] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This study explores the interactions among phases of team coordination, patient-related information, decision-making levels, and role holders in intensive care units (ICUs). BACKGROUND The effects of communication improvement initiatives on adverse patient events or improved outcomes have been difficult to establish. Conceptual inconsistencies and methodological shortcomings suggest insufficient understanding about clinical communication and care coordination. METHOD Data were collected by shadowing a charge nurse, fellow, resident, and nurse in each of eight ICUs and recording each of their conversations during 12 hrs (32 role holders during 350 hrs). RESULTS Hierarchical log linear analyses show statistically significant three-way interactions between the patient information, phases of team coordination, and decision levels, chi2(df = 75) = 212, p < .0001; between roles, phases of team coordination, and decision levels, chi2(df = 60) = 109, p < .0001; and between roles, patient information, and decision levels, chi2(df = 60) = 155, p < .0001. Differences among levels of the variables were evaluated with the use of standardized parameter estimates and 95% confidence intervals. CONCLUSION ICU communication and care coordination involve complex decision structures and role interactions across two information spaces. Different role holders mediate vertical and lateral process flows with goals and directions representing an important conceptual transition. However, lateral isolation within decision levels (charge nurses) and information overload (residents) are potential communication and care coordination vulnerabilities. Results are consistent with and extend the findings of previous studies. APPLICATION The profile of ICU communication and care coordination provides a systemic framework that may inform future interventions and research.
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Affiliation(s)
- Anne Miller
- Vanderbilt University, Center for Perioperative Research in Quality, Nashville, Tennessee 37212, USA.
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Miller A, Pilcher D, Mercaldo N, Leong T, Scheinkestel C, Schildcrout J. What can paper-based clinical information systems tell us about the design of computerized clinical information systems (CIS) in the ICU? Aust Crit Care 2010; 23:130-40. [PMID: 20346695 DOI: 10.1016/j.aucc.2010.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 12/16/2009] [Accepted: 02/05/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Screen designs in computerized clinical information systems (CIS) have been modeled on their paper predecessors. However, limited understanding about how paper forms support clinical work means that we risk repeating old mistakes and creating new opportunities for error and inefficiency as illustrated by problems associated with computerized provider order entry systems. PURPOSE This study was designed to elucidate principles underlying a successful ICU paper-based CIS. The research was guided by two exploratory hypotheses: (1) paper-based artefacts (charts, notes, equipment, order forms) are used differently by nurses, doctors and other healthcare professionals in different (formal and informal) conversation contexts and (2) different artefacts support different decision processes that are distributed across role-based conversations. METHOD All conversations undertaken at the bedsides of five patients were recorded with any supporting artefacts for five days per patient. Data was coded according to conversational role-holders, clinical decision process, conversational context and artefacts. 2133 data points were analyzed using Poisson logistic regression analyses. RESULTS Results show significant interactions between artefacts used during different professional conversations in different contexts (chi(2)((df=16))=55.8, p<0.0001). The interaction between artefacts used during different professional conversations for different clinical decision processes was not statistically significant although all two-way interactions were statistically significant. CONCLUSIONS Paper-based CIS have evolved to support complex interdisciplinary decision processes. The translation of two design principles - support interdisciplinary perspectives and integrate decision processes - from paper to computerized CIS may minimize the risks associated with computerization.
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Affiliation(s)
- A Miller
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Miller A, Scheinkestel C, Joseph M, Hospital A. Coordination and continuity of intensive care unit patient care. HUMAN FACTORS 2009; 51:354-367. [PMID: 19750797 DOI: 10.1177/0018720809340032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Using Klein's model of team coordination, we explored the null hypothesis that intensive care unit (ICU) care coordination unfolds as a linear sequence. Our intent was to generate hypotheses for further research and to provide interim recommendations for improving care coordination. We also explored factors contributing to care coordination (e.g., role responsibilities, support tools). BACKGROUND Although the body of clinical communications research is considerable, few studies address broader team processes in real-world environments; hence, these processes are not well understood. METHODS All bedside communications for 5 ICU patients were recorded for 5 days per patient and were coded using Klein's model. Markov analysis was used to describe the care coordination process. Multivariate contingency table analysis and standardized parameter estimates described important contributing factors, and support tools were described using descriptive statistics. RESULTS First-, second-, and third-order Markov analyses show that care coordination does not unfold as a linear sequence; however, Markov diagrams suggest some process structure. Standardized parameter estimates of factors contributing to care coordination were calculated from a statistically significant three-way model (chi2[df= 18] = 36.95, p < .005). Role-based differences depend on context, with important differences in contributions to care coordination occurring within rounds. Tools supported only 48% of conversations. CONCLUSION Three alternative research hypotheses were defined with at least a minimal level of support. Testing these hypotheses present substantial theoretical, methodological, and data analysis challenges. APPLICATION Within a research framework, recommendations for change could achieve significant gains for understanding and for reducing breakdowns in care coordination.
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Affiliation(s)
- Anne Miller
- Vanderbilt University Medical Center, Center for Perioperative Research in Quality, 1211 21st Avenue South, Nashville, TN 37212, USA.
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