title: Crossing the handover chasm: Clinicians' perceptions of barriers to the early detection and timely management of severe sepsis and septic shock.
abstract: The purpose was to identify barriers to the early detection and timely management of severe sepsis throughout the emergency department (ED), general ward (GW), intermediate care unit (IMC), and the intensive care unit (ICU).
  
  
  
  Five multicenter focus group discussions with 29 clinicians were conducted. Discussions were based on a moderation guide were recorded and transcribed. Qualitative analysis was performed according to the principles of the concept mapping method and the framework approach.
  
  
  
  The major causes of the delayed detection and treatment could be summarized in a framework of communication errors and handover difficulties throughout patients' course of treatment, which can be divided into 5 core areas: inadequate histories before hospital admission; poorly coordinated handovers between the ambulance service and the ED; delayed patient transfer between the ED and the GW as well as delays in patient transfers between the GW and the ICU by, for example, a lack of bed capacity and a shortage of staff. Generally, participants from all wards mentioned that the urgency with which septic patients needed to be treated was not communicated.
  
  
  
  Our study shows the need to improve intra- and interunit handover processes in hospital care, which would ensure a holistic treatment concept, thereby improving patient care.
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: claudia.matthaeus@med.uni-jena.de.
authors.forename: Claudia T
authors.initials: CT
authors.lastname: Matthaeus-Kraemer
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: daniel.thomas@med.uni-jena.de.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Thomas-Rueddel
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: daniel.schwarzkopf@med.uni-jena.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwarzkopf
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: hendrik.rueddel@med.uni-jena.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Rueddel
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: poidinger@gmx.at.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Poidinger
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: konrad.reinhart@med.uni-jena.de.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: frank.bloos@med.uni-jena.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Bloos
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D061345:Early Medical Intervention; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D017144:Focus Groups; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units; D009726:Nurses; D062209:Patient Handoff; D010465:Perception; D010820:Physicians; D036301:Qualitative Research; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis* / Q000628:therapy
keywords: Barriers to treatment; Critical care; Focus group discussion; Qualitative research; Quality improvement