title: The collaborative communication model for patient handover at the interface between high-acuity and low-acuity care.
abstract: BACKGROUND
  Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events.
  
  
  OBJECTIVE
  We analysed the communications between high-acuity and low-acuity units, their content and social context, and we explored whether common conceptual ground reduced potential threats to patient safety posed by current handover practices.
  
  
  METHODS
  We monitored the communication of five content items using handover probes for 22 patient transitions of care between high-acuity 'sender units' and low-acuity 'recipient units'. Data were analysed and discussed in focus groups with healthcare professionals to acquire insights into the characteristics of the common conceptual ground.
  
  
  RESULTS
  High-acuity and low-acuity units agreed about the presence of alert signs in the discharge form in 40% of the cases. The focus groups identified prehandover practices, particularly for anticipatory guidance that relied extensively on verbal phone interactions that commonly did not involve all members of the healthcare team, particularly nursing. Accessibility of information in the medical records reported by the recipient units was significantly lower than reported by sender units. Common ground to enable interpretation of the complete handover content items existed only among selected members of the healthcare team.
  
  
  CONCLUSIONS
  The limited common ground reduced the likelihood of correct interpretation of important handover information, which may contribute to adverse events. Collaborative design and use of a shared set of handover content items may assist in creating common ground to enable clinical teams to communicate effectively to help increase the reliability and safety of cross-unit handovers.
authors.affiliation: Clinical Risk Management and Patient Safety Centre-Tuscany Region, Via Taddeo Alderotti 26N, Firenze 50139, Italy. toccafondig@aou-careggi.toscana.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Toccafondi
authors.forename: Sara
authors.initials: S
authors.lastname: Albolino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Tartaglia
authors.forename: Stefano
authors.initials: S
authors.lastname: Guidi
authors.forename: Antonio
authors.initials: A
authors.lastname: Molisso
authors.forename: Francesco
authors.initials: F
authors.lastname: Venneri
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
authors.forename: Filippo
authors.initials: F
authors.lastname: Pieralli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Magnelli
authors.forename: Marco
authors.initials: M
authors.lastname: Librenti
authors.forename: Marco
authors.initials: M
authors.lastname: Morelli
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
mesh_terms: D057189:Checklist; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D003299:Cooperative Behavior; D003625:Data Collection; D005060:Europe; D017144:Focus Groups; D006784:Hospitals, Teaching; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000592:standards; D017146:Models, Organizational; D010348:Patient Care Team; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards