title: Impact of an electronic handoff documentation tool on team shared mental models in pediatric critical care.
abstract: To examine the impact of the implementation of an electronic handoff tool (the Handoff Tool) on shared mental models (SMM) within patient care teams as measured by content overlap and discrepancies in verbal handoff presentations given by different clinicians caring for the same patient.
  
  
  
  Researchers observed, recorded, and transcribed verbal handoffs given by different members of patient care teams in a pediatric intensive care unit. The transcripts were qualitatively coded and analyzed for content overlap scores and the number of discrepancies in handoffs of different team members before and after the implementation of the tool.
  
  
  
  Content overlap scores did not change post-implementation. The average number of discrepancies nearly doubled following the implementation (from 0.76 discrepancies per handoff group pre-implementation to 1.17 discrepancies per handoff group post-implementation); however, this change was not statistically significant (p=0.37). Discrepancies classified as related to dosage of treatment or procedure and to patients' symptoms increased in frequency post-implementation.
  
  
  
  The results suggest that the Handoff Tool did not have the desired positive impact on SMM within patient care teams. Future electronic tools for facilitating team handoff may need longer implementation times, complementary changes to handoff process and structure, and improved designs that integrate a common core of shared information with discipline-specific records.
  
  
  
  While electronic handoff tools provide great opportunities to improve communication and facilitate the formation of shared mental models within patient care teams, further work is necessary to realize their full potential.
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States. Electronic address: syj2108@cumc.columbia.edu.
authors.forename: Silis Y
authors.initials: SY
authors.lastname: Jiang
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States.
authors.forename: Alexandrea
authors.initials: A
authors.lastname: Murphy
authors.affiliation: School of Nursing, Columbia University, United States.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Heitkemper
authors.affiliation: Department of Pediatrics, College of Physicians and Surgeons, Columbia University, United States.
authors.forename: R Stanley
authors.initials: RS
authors.lastname: Hum
authors.affiliation: Department of Biomedical Informatics, Arizona State University, United States; Mayo Clinic Arizona, United States.
authors.forename: David R
authors.initials: DR
authors.lastname: Kaufman
authors.affiliation: Department of Biomedical Informatics, Columbia University, United States.
authors.forename: Lena
authors.initials: L
authors.lastname: Mamykina
mesh_terms: D002648:Child; D003142:Communication; D003422:Critical Care; D004282:Documentation; D057286:Electronic Health Records; D006801:Humans; D008960:Models, Psychological; D062209:Patient Handoff
keywords: Discrepancy; Handoff; Health IT; Shared mental models