title: Hip-fracture care in rural southwestern ontario: an ethnographic study of patient transitions and physiotherapy handoffs.
abstract: OBJECTIVE
  To examine information exchange by physiotherapists during care handoffs of patients with hip fracture in a rural health care setting.
  
  
  METHODS
  This qualitative ethnographic study used observation and interviews of 11 networks of patients with hip fracture (n=11), family caregivers (n=8), and health care providers (n=24). Patients were followed from acute care through each subsequent care setting. Data were supplemented by health care records and policy documents.
  
  
  RESULTS
  Findings revealed that handoffs were less successful when information transfer was untimely or incomplete. Family caregivers experienced challenges in obtaining information required to facilitate the handoff, especially when direct contact with physiotherapists was not possible as a result of distance or other factors. Physiotherapists had to navigate multiple data sources to retrieve important information, and managed information gaps in various ways. Information flow was often unidirectional and suggested no further clinical accountability for the discharging physiotherapist.
  
  
  CONCLUSIONS
  Providing information in a structured and timely fashion facilitated physiotherapy handoffs. Inadequate handoffs compromised continuity of care, delayed progress in rehabilitation, and resulted in families' missing information of vital importance to their caregiving role. A multi-directional exchange of information is needed between patients, families, and health care providers across care settings.
authors.affiliation: Chatham-Kent Health Alliance, Chatham, Ont.
authors.forename: Helen
authors.initials: H
authors.lastname: Johnson
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Forbes
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ont.
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Egan
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Ont.
authors.forename: Jacobi
authors.initials: J
authors.lastname: Elliott
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Ont.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
authors.affiliation: School of Physical Therapy, Faculty of Health Sciences ; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont.
authors.forename: Bert M
authors.initials: BM
authors.lastname: Chesworth
keywords: continuity of patient care; hip fractures; qualitative research; rural health services