Elsevier

Journal of Critical Care

Volume 29, Issue 2, April 2014, Pages 311.e1-311.e7
Journal of Critical Care

Electronic Article
Comparative evaluation of the content and structure of communication using two handoff tools: Implications for patient safety,☆☆,,★★

https://doi.org/10.1016/j.jcrc.2013.11.014Get rights and content

Abstract

Purpose

Handoffs vary in their structure and content, raising concerns regarding standardization. We conducted a comparative evaluation of the nature and patterns of communication on 2 functionally similar but conceptually different handoff tools: Subjective, Objective, Assessment and Plan, based on a patient problem-based format, and Handoff Intervention Tool (HAND-IT), based on a body system-based format.

Method

A nonrandomized pre-post prospective intervention study supported by audio recordings and observations of 82 resident handoffs was conducted in a medical intensive care unit. Qualitative analysis was complemented with exploratory sequential pattern analysis techniques to capture the characteristics and types of communication events (CEs) and breakdowns.

Results

Use of HAND-IT led to fewer communication breakdowns (F1,80 = 45.66: P < .0001), greater number of CEs (t40 = 4.56; P < .001), with more ideal CEs than Subjective, Objective, Assessment and Plan (t40 = 9.27; P < .001). In addition, the use of HAND-IT was characterized by more request-response CE transitions.

Conclusion

The HAND-IT's body system-based structure afforded physicians the ability to better organize and comprehend patient information and led to an interactive and streamlined communication, with limited external input. Our results also emphasize the importance of information organization using a medical knowledge hierarchical format for fostering effective communication.

Section snippets

Background and significance

Patient handoffs refer to the transfer of care services between providers during care transitions [1], [2], [3]. Although handoffs are key to maintaining continuity of care [4], they are considered a threat to patient safety due to the inherent breakdowns and errors in their execution. Earlier reports have suggested that handoff breakdowns contribute to nearly 35% of medical errors and adverse events [5]. These errors arise as a result of a variety of communication challenges caused by

Method

This study was part of a larger study involving the evaluation of handoffs in critical care settings. This article focuses on the comparative evaluation of 2 handoff tools: SOAP and HAND-IT.

Results

We report on the differences in the nature and patterns of communication behavior using SOAP and HAND-IT. We report on 4 attributes: communication interactivity, measured by the type/distribution of CEs; communication optimality, measured by the type of CEs (ideal vs nonideal); communication breakdowns, measured by the number of missed, incorrect, or irrelevant information from sender and team and; communication support, measured by the probability of “reject” and “request” sequences of CEs.

Discussion

Based on a comparative evaluation of the communication behavior between handoff tools, we found that an indigenously developed system-based handoff tool, HAND-IT, was characterized by greater communication interactivity, greater communication optimality, fewer communication breakdowns, and greater communication support. Furthermore, we found that the communication breakdowns with HAND-IT were only marginally related to the diagnostic, treatment, or management aspects of patient care. Based on

Conclusion

Our results suggest that HAND-IT supports a holistic and comprehensive head-to-toe, evidence-based assessment of a critical care patient. Such an information framework for patient data organization and documentation supported consistent, systematic, and streamlined communication with fewer breakdowns, potentially leading to better continuity and coordination of care. Although further longitudinal evaluation and evaluation in other settings are necessary for establishing the long-term viability

Acknowledgments

We would like to thank all the clinicians who participated in this study. Special thanks to 4 anonymous reviewers who provided valuable insights that has greatly improved this article.

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    This research was conducted at the University of Texas Health Science Center, Houston, TX.

    ☆☆

    Contribution: JA conceived the study and collected the data. JA coded all transcripts, whereas TK coded 25% of the transcripts for reliability analysis. JA and TK performed all qualitative and quantitative analysis. All authors participated in the interpretation of data, helped to draft the article or revise it critically for important intellectual content, and gave final approval of the version to be published.

    The authors were supported by a grant from the James S. McDonnell Foundation on Cognitive Complexity and Error in Critical Care (grant 220020152 to Vimla L. Patel).

    ★★

    Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: all authors were supported by a funding from the James S. McDonnell Foundation; no financial relationships with any other organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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