title: Bridging gaps in handoffs: a continuity of care based approach.
abstract: Handoff among healthcare providers has been recognized as a major source of medical errors. Most prior research has often focused on the communication aspects of handoff, with limited emphasis on the overall handoff process, especially from a clinician workflow perspective. Such a workflow perspective that is based on the continuity of care model provides a framework required to identify and support an interconnected trajectory of care events affecting handoff communication. To this end, we propose a new methodology, referred to as the clinician-centered approach that allows us to investigate and represent the entire clinician workflow prior to, during and, after handoff communication. This representation of clinician activities supports a comprehensive analysis of the interdependencies in the handoff process across the care continuum, as opposed to a single discrete, information sharing activity. The clinician-centered approach is supported by multifaceted methods for data collection such as observations, shadowing of clinicians, audio recording of handoff communication, semi-structured interviews and artifact identification and collection. The analysis followed a two-stage mixed inductive-deductive method. The iterative development of clinician-centered approach was realized using a multi-faceted study conducted in the Medical Intensive Care Unit (MICU) of an academic hospital. Using the clinician-centered approach, we (a) identify the nature, inherent characteristics and the interdependencies between three phases of the handoff process and (b) develop a descriptive framework of handoff communication in critical care that captures the non-linear, recursive and interactive nature of collaboration and decision-making. The results reported in this paper serve as a "proof of concept" of our approach, emphasizing the importance of capturing a coordinated and uninterrupted succession of clinician information management and transfer activities in relation to patient care events.
authors.affiliation: Center for Cognitive Informatics and Decision Making, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX 77030, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Abraham
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Kannampallil
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D003657:Decision Making; D006282:Health Personnel; D006801:Humans; D007362:Intensive Care Units; D019300:Medical Errors / Q000517:prevention & control; D016347:Medical Records Systems, Computerized; D010360:Patient Transfer / Q000592:standards*