title: Comparative evaluation of the content and structure of communication using two handoff tools: implications for patient safety.
abstract: OBJECTIVE
  Handoffs vary in their structure and content, raising concerns regarding standardization. We conducted a comparative evaluation of the nature and patterns of communication on 2 functionally similar but conceptually different handoff tools: Subjective, Objective, Assessment and Plan, based on a patient problem-based format, and Handoff Intervention Tool (HAND-IT), based on a body system-based format.
  
  
  METHODS
  A nonrandomized pre-post prospective intervention study supported by audio recordings and observations of 82 resident handoffs was conducted in a medical intensive care unit. Qualitative analysis was complemented with exploratory sequential pattern analysis techniques to capture the characteristics and types of communication events (CEs) and breakdowns.
  
  
  RESULTS
  Use of HAND-IT led to fewer communication breakdowns (F1,80 = 45.66: P < .0001), greater number of CEs (t40 = 4.56; P < .001), with more ideal CEs than Subjective, Objective, Assessment and Plan (t40 = 9.27; P < .001). In addition, the use of HAND-IT was characterized by more request-response CE transitions.
  
  
  CONCLUSIONS
  The HAND-IT's body system-based structure afforded physicians the ability to better organize and comprehend patient information and led to an interactive and streamlined communication, with limited external input. Our results also emphasize the importance of information organization using a medical knowledge hierarchical format for fostering effective communication.
authors.affiliation: Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois, Chicago, IL. Electronic address: abrahamj@uic.edu.
authors.forename: Joanna
authors.initials: J
authors.lastname: Abraham
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Kannampallil
authors.affiliation: Department of Internal Medicine, Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: Almoosa
authors.affiliation: Department of Internal Medicine, Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX.
authors.forename: Bela
authors.initials: B
authors.lastname: Patel
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY.
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
mesh_terms: D057189:Checklist; D003142:Communication; D065187:Controlled Before-After Studies; D006801:Humans; D007362:Intensive Care Units; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards; D061214:Patient Safety; D018794:Problem-Based Learning; D011446:Prospective Studies; D036301:Qualitative Research
keywords: Care continuity; Critical care; Handovers; Information transfer