title: Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians.
abstract: Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.
authors.affiliation: School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus (Mr Mount-Campbell and Dr Patterson) Department of Integrated Systems Engineering, The Ohio State University (Drs Rayo and Allen); and Quality and Patient Safety, Riverside Methodist Hospital, Columbus, Ohio (Dr O'Brien).
authors.forename: Austin F
authors.initials: AF
authors.lastname: Mount-Campbell
authors.forename: Michael F
authors.initials: MF
authors.lastname: Rayo
authors.forename: James J
authors.initials: JJ
authors.lastname: OʼBrien
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Allen
authors.forename: Emily S
authors.initials: ES
authors.lastname: Patterson
mesh_terms: D000367:Age Factors; D000884:Anthropology, Cultural; D003142:Communication; D005190:Family; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007396:Internship and Residency; D062209:Patient Handoff / Q000458:organization & administration*; D010820:Physicians; D013997:Time Factors