In search of common ground in handoff documentation in an Intensive Care Unit

Abstract

ObjectiveHandoff is an intra-disciplinary process, yet the flow of critical handoff information spans multiple disciplines. Understanding this information flow is important for the development of computer-based tools that supports the communication and coordination of patient care in a multi-disciplinary and highly specialized critical care setting. We aimed to understand the structure, functionality, and content of nurses’ and physicians’ handoff artifacts. DesignWe analyzed 22 nurses’ and physicians’ handoff artifacts from a Cardiothoracic Intensive Care Unit (CTICU) at a large urban medical center. We combined artifact analysis with semantic coding based on our published Interdisciplinary Handoff Information Coding (IHIC) framework for a novel two-step data analysis approach. ResultsWe found a high degree of structure and overlap in the content of nursing and physician artifacts. Our findings demonstrated a non-technical, yet sophisticated, system with a high degree of structure for the organization and communication of patient data that functions to coordinate the work of multiple disciplines in a highly specialized unit of patient care. LimitationsThis study took place in one CTICU. Further work is needed to determine the generalizability of the results. ConclusionsOur findings indicate that the development of semi-structured patient-centered interdisciplinary handoff tools with discipline specific views customized for specialty settings may effectively support handoff communication and patient safety.