title: The unappreciated challenges of between-unit handoffs: negotiating and coordinating across boundaries.
abstract: Although interest in studying and improving handoffs has grown considerably in recent years, a general tendency to treat handoff as a single type of activity has resulted in overlooking important variation and in understudying one consequential type: between-unit handoffs. Using the admission handoff between emergency departments and inpatient services as an example, this conceptual article identifies 2 distinguishing structural features of between-unit transitions and demonstrate how these features create negotiation and coordination challenges that are further complicated by several contextual factors. Between-unit handoffs are distinguished from within-unit handoffs because the former are triggered by patient conditions as opposed to shift schedules and entail working across organizational boundaries rather than within them. Consequently, between-unit handoffs are challenged by several contextual factors, including interprofessional differences, unequal distributions of power among units, frequent lack of established relationships among the involved parties, infrequent face-to-face communication, a lack of awareness of the other unit's state, and the fact that responsibility and control of patients are transferred separately. Implications for improvement are discussed.
authors.affiliation: Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, USA. bhilligoss@cph.osu.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Hilligoss
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cohen
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration; D006801:Humans; D007373:Interinstitutional Relations; D007391:International Cooperation; D017008:Negotiating; D010360:Patient Transfer / Q000379:methods / Q000458:organization & administration