Bridging gaps in handoffs: A continuity of care based approach

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.

This represents the information sharing behavior between clinicians (sender and receiver) during handoff activity in a critical care setting. This framework highlights two activities that occur during group handoff communication in any academic hospital: first, an outgoing team-driven information presentation that occurs during the initial part of the handoff and second, an oncoming team-driven learning and explanation activity that evolves during decision-making and collaborative problem solving cycles.Figure optionsDownload high-quality image (138 K)Download as PowerPoint slideHighlights
► Clinician-centered approach based on the continuity of care model captures information flow between practitioners.
► Significant interdependencies exist between handoff phases.
► Handoff communication framework highlights potential points and contributors of information breakdowns.