title: Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses' handoffs on medical and surgical units: insights from interviews and observations.
abstract: Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses' use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor's electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer "at a glance" information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.
authors.affiliation: School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA. staggers@son.umaryland.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Staggers
authors.forename: Lauren
authors.initials: L
authors.lastname: Clark
authors.forename: Jacquelyn W
authors.initials: JW
authors.lastname: Blaz
authors.forename: Seraphine
authors.initials: S
authors.lastname: Kapsandoy
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities; D003071:Cognition; D003266:Continuity of Patient Care; D057286:Electronic Health Records; D005260:Female; D005568:Forms and Records Control / Q000379:methods*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D013503:Surgery Department, Hospital; D013637:Tape Recording; D014481:United States; D055815:Young Adult