Multi-level, multi-discipline, and temporally-diverse handoffs in traumatic brain injury rehabilitation

Abstract

Traumatic brain injury (TBI) affects approximately 1.7 million Americans annually, and over 5.3 million people in the US are living with a TBI-related disability. Recently the TBI rehabilitation community has championed for TBI to be viewed as a chronic condition, rather than a discrete event. Effective TBI care across the care continuum requires substantial coordination of a variety of clinical types and handoffs between providers, yet these handoffs have not yet been systematically identified. For this exploratory research study, data were collected using semi-structured ethnographic interviews (n=32) with professional care providers in TBI rehabilitation. Study findings identified the patient handoffs across various “levels” of the care system, which range from the shift-change level to the healthcare system transfer level. These handoffs occur over different time scales, and certain types of information are more likely to be lost at certain handoff points. Facility handoffs within the same health systems are also susceptible to incomplete handoffs. Recommendations for improvement and areas for future work include information system (re)design, social network analysis and modeling, and more comprehensive handoff research.