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Abstract

The need for 24 times 7 × 365 service in emergency departments (EDs) requires physicians and other health professionals to work in temporally delimited shifts. Handoffs between on-coming and off-going workers at shift changes are used to bridge gaps in care and to prepare the on-coming party to assume the ongoing work of care safely and effectively. We audio-recorded shift change conversations at 4 North American EDs and analysed them using a conversational framework. We compare these conversations among ED workers to reports of similar handoff conversations occurring between ED physicians and hospitalist at the time of patient admission. We found receiving parties in ED shift changes to be more active in the elicitation of information, rather than being passive recipients of information. This suggests that a co-construction or distributed cognition framing of handoffs may be more useful in understanding and improving handoffs than the information transfer framing commonly assumed by medically oriented researchers, at least in this setting.

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References

Apker

Mallak

L. A.

Applegate

E. B.

Gibson

S. C.

Ham

J. J.

Johnson

N. A.

. (2010). Exploring Emergency Physician–Hospitalist Handoff Interactions: Development of the Handoff Communication Assessment. Annals of Emergency Medicine, 55(2), 161–170.

Arora

Johnson

Lovinger

Humphrey

H. J.

Meltzer

D. O.

(2005). Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. Qual Saf Health Care, 14(6), 401–407.

Arora

V. M.

Johnson

J. K.

Meltzer

D. O.

Humphrey

H. J.

(2008). A theoretical framework and competency-based approach to improving handoffs. Qual Saf Health Care, 17(1), 11–14. doi: 10.1136/qshc.2006.018952.

Borowitz

S. M.

Waggoner-Fountain

L. A.

Bass

E. J.

Sledd

R. M.

(2008). Adequacy of information transferred at resident sign-out (inhospital handover of care): A prospective survey. Qual Saf Health Care, 17(1), 6–10. doi: 10.1136/qshc.2006.019273.

Brandwijk

Nemeth

O'connor

Kahana

Cook

R. I.

(2003, 27 January 2003). Distributing cognition: ICU handoffs conform to Grice's maxims Retrieved 27 January 2003, from http://www.ctlab.org/properties/pdf%20files/SCCM%20Poster%201.27.03.pdf .

Cohen

M. D.

Hilligoss

P. B.

(2009, January 2009). Handoffs in hospitals: a reivew of the literature on information exchange while transferring patient responsibility or control Retrieved 12 June 2009, from http://deepblue.lib.umich.edu/handle/2027.42/61522 .

Dayton

Henriksen

(2007). Communication failure: Basic components, contributing factors, and the call for structure. Jt Comm J Qual Patient Saf, 33(1), 34–47.

Department of Defense. (2006). Healthcare Communications Toolkit to Improve Transitions in Care Retrieved 5 September 2006, from http://www.usuhs.mil/cerps/documents/Handoff_Toolkit.pdf .

Eisenberg

E. M.

(2008). The Social Construction of Health Care Teams. In Nemeth

(Ed.), Improving healthcare team communication: Building on lessons from aviation and aerospace: Ashgate Publishing.

10.

Gandhi

T. K.

(2005). Fumbled Handoffs: One Dropped Ball after Another. Ann Intern Med, 142(5), 352–358.

11.

Gee

J. P.

(2005). An Introduction to Discourse Analysis: Theory and Method. Abingdon, UK: Routledge.

12.

Hilligoss

P. B.

Cohen

M. D.

(2010). What is the goal of patient handoff? Implications for the improvement of care transitions. Paper presented at the Computer-Supported Cooperative Work: Handoffs Workshop, Savannah, GA.

13.

Kitch

B. T.

Cooper

J. B.

Zapol

W. M.

Marder

J. E.

Karson

Hutter

. (2008). Handoffs causing patient harm: A survey of medical and surgical house staff. Jt Comm J Qual Patient Saf, 34(10), 563–570.

14.

Patterson

E. S.

Wears

R. L.

(2010). Patient handoffs: Standardized and reliable measurement tools remain elusive. Joint Commission Journal on Quality & Patient Safety, 36(2), 52–61.

15.

Petersen

L. A.

Orav

E. J.

Teich

J. M.

O'neil

A. C.

Brennan

T. A.

(1998). Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv, 24(2), 77–87.

16.

Salluzo

R. F.

Mayer

T. A.

Strauss

R. W.

Kidd

(1997). Emergency Department Management: Principles and Applications. St Louis, MO: Mosby.

17.

Schiffrin

Tannen

Hamilton

H. E.

(Eds.). (2003). Handbook of Discource Analysis. Malden, MA: Blackwell Publishing Ltd.

18.

Sherlock

(1995). The patient handover: A study of its form, function and efficiency. Nurs Stand, 9(52), 33–36.

19.

Solet

D. J.

Norvell

J. M.

Rutan

G. H.

Frankel

R. M.

(2005). Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs. Acad Med, 80(12), 1094–1099.

20.

Wears

R. L.

(2010). Issues surrounding handoffs. Paper presented at the Computer-Supported Cooperative Work: Handoffs Workshop, Savannah, GA.

21.

Wears

R. L.

Perry

S. J.

Shapiro

Beach

Behara

(2003). Shift changes among emergency physicians: best of times, worst of times. Paper presented at the Human Factors and Ergonomics Society 47th Annual Meeting, Denver, CO.

Discourse and Process Analyses of Shift Change Handoffs in Emergency Departments

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