J Biomed Inform - Bridging gaps in handoffs: a continuity of care based approach.

Tópicos

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Resumo

Handoff among healthcare providers has been recognized as a major source of medical errors. Most prior research has often focused on the communication aspects of handoff, with limited emphasis on the overall handoff process, especially from a clinician workflow perspective. Such a workflow perspective that is based on the continuity of care model provides a framework required to identify and support an interconnected trajectory of care events affecting handoff communication. To this end, we propose a new methodology, referred to as the clinician-centered approach that allows us to investigate and represent the entire clinician workflow prior to, during and, after handoff communication. This representation of clinician activities supports a comprehensive analysis of the interdependencies in the handoff process across the care continuum, as opposed to a single discrete, information sharing activity. The clinician-centered approach is supported by multifaceted methods for data collection such as observations, shadowing of clinicians, audio recording of handoff communication, semi-structured interviews and artifact identification and collection. The analysis followed a two-stage mixed inductive-deductive method. The iterative development of clinician-centered approach was realized using a multi-faceted study conducted in the Medical Intensive Care Unit (MICU) of an academic hospital. Using the clinician-centered approach, we (a) identify the nature, inherent characteristics and the interdependencies between three phases of the handoff process and (b) develop a descriptive framework of handoff communication in critical care that captures the non-linear, recursive and interactive nature of collaboration and decision-making. The results reported in this paper serve as a "proof of concept" of our approach, emphasizing the importance of capturing a coordinated and uninterrupted succession of clinician information management and transfer activities in relation to patient care events.

Resumo Limpo

handoff among healthcar provid recogn major sourc medic error prior research often focus communic aspect handoff limit emphasi overal handoff process especi clinician workflow perspect workflow perspect base continu care model provid framework requir identifi support interconnect trajectori care event affect handoff communic end propos new methodolog refer cliniciancent approach allow us investig repres entir clinician workflow prior handoff communic represent clinician activ support comprehens analysi interdepend handoff process across care continuum oppos singl discret inform share activ cliniciancent approach support multifacet method data collect observ shadow clinician audio record handoff communic semistructur interview artifact identif collect analysi follow twostag mix inductivededuct method iter develop cliniciancent approach realiz use multifacet studi conduct medic intens care unit micu academ hospit use cliniciancent approach identifi natur inher characterist interdepend three phase handoff process b develop descript framework handoff communic critic care captur nonlinear recurs interact natur collabor decisionmak result report paper serv proof concept approach emphas import captur coordin uninterrupt success clinician inform manag transfer activ relat patient care event

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