title: Revealing structures in narratives: A mixed-methods approach to studying interdisciplinary handoff in critical care.
abstract: To examine a novel mixed-methods approach for studying patterns of clinical communication that could inform future informatics solutions, with a specific focus on handoff within interdisciplinary teams.
  
  
  
  Researchers observed, recorded, and transcribed verbal handoff discussions of different members of critical care teams. The transcripts were coded qualitatively, and then analyzed quantitatively for emerging structural patterns using categorical cluster analysis, and for degree of shared mental models (SMM) using the modified Pyramid method.
  
  
  
  An empirical study using the proposed mixed-methods approach suggested emerging patterns of communication among clinicians. For example, the temporal focus of handoff was often determined by the role of the clinician giving the handoff; the clinical content of handoff was consistent between clinicians, but varied between patients. The SMM index ranged from 0.065 (with the maximum possible overlap score of 1) to 0.007 with a median of 0.026; the overlap was higher in statements concerned with patient presentation (23.6% of these had overlap) and referring to the past (24% overlapped). This calculated SMM index was correlated with the assessment of coherence within the participating teams by independent physicians (r=0.63, p=0.038).
  
  
  
  The proposed novel mixed-methods approach helped to reveal emerging patterns in content and structure of handoff communication and highlight differences due to the clinical context, and to the different priorities of clinicians on interdisciplinary patient care teams. The approach for calculating SMM is more ecologically sensitive as it relies on naturally occurring discourse and less intrusive than traditional ways of assessing SMM, and takes initial steps toward establishing empirical foundation for the design of electronic tools to support handoff in interdisciplinary teams.
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States. Electronic address: lena.mamykina@dbmi.columbia.edu.
authors.forename: Lena
authors.initials: L
authors.lastname: Mamykina
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States.
authors.forename: Silis
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Clinical Informatics, Partners Healthcare Systems, United States; Department of General Internal Medicine and Primary Care, Harvard Medical School and Brigham and Women's Hospital, United States.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Collins
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States.
authors.forename: Bridget
authors.initials: B
authors.lastname: Twohig
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States.
authors.forename: Jamie
authors.initials: J
authors.lastname: Hirsh
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States.
authors.forename: George
authors.initials: G
authors.lastname: Hripcsak
authors.affiliation: Department of Pediatrics, College of Physicians and Surgeons, Columbia University, United States.
authors.forename: R
authors.initials: R
authors.lastname: Stanley Hum
authors.affiliation: Biomedical Informatics, Arizona State University, United States; Mayo Clinic Arizona, United States.
authors.forename: David R
authors.initials: DR
authors.lastname: Kaufman
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D003422:Critical Care; D006801:Humans; D033262:Narration; D062209:Patient Handoff
keywords: Clinical communication; Electronic documentation; Handoff; Shared mental models; Teamwork