“Anybody on this list that you're more worried about?” Qualitative analysis exploring the functions of questions during end of shift handoffs

Abstract

Background Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective To investigate questions and the functions they serve in nursing and medicine handoffs.Research design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical internto-intern handoffs. Subjects Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of

Change‐of‐Shift Nursing Handoff Interruptions: Implications for Evidence‐Based Practice

“…Findings from this study confirm that handoff involves development of a shared mental model (Pfrimmer et al, ; Rhudy & Androwich, ; Riley, Merritt, Mize, Schuette, & Berger, ) that contributes to the objective of handoff: the transfer of accurate patient data to another clinician (Kowitlawakul et al, ; O'Brien, Fanagan, Bergman, Ebright, & Frankel, ). In addition, the value of the conversational, back and forth, handoff interaction is a key finding.…”

“…Questions and comments served to ensure the oncoming nurse was prepared with adequate information so that care would continue without error and confirmed the receiver was actively attending to the information. O'Brien et al () examined the role of questioning in face‐to‐face handoffs. They found the number of questions per handoff ranged from 0 to 13 with an average of 3.5; as in this study, receiving nurses asked far more questions.…”

“…They found the number of questions per handoff ranged from 0 to 13 with an average of 3.5; as in this study, receiving nurses asked far more questions. Whether the high volume of questions asked by receiving nurses represents missing or incomplete information from the giving nurse is not known (O'Brien et al, ).…”

The handover room: a qualitative enquiry into the experience of morning clinical handover for acute medical teams

“…All handover entails the exchange of information, but the research also suggests that complex social and organisational factors are always in play. Consequently there is a need to develop a rich contextually sensitive understanding of the social dynamics of handover . For instance, a recent study concluded that tools and procedures designed to improve end‐of‐shift handovers through standardisation of processes and reliance on technology may miss contextually sensitive information about anticipated events.…”

Can we talk? The art (and science) of handoff conversation

“…In addition to AMC from senders, questions from receivers play an important role in co-constructing the course, direction and outcome of the handoff. As part of the same study, but in a separate paper included in this issue, ‘“Anybody on this list that you're more worried about?” Qualitative analysis exploring the functions of questions during end of shift handoffs’, O'Brien and colleagues conducted a qualitative analysis of the function of questions during end-of-shift handoffs 2. Their analysis revealed that, not surprisingly, the vast majority of questions are asked by the incoming health professional to help elicit more information to understand the individual patient and to plan care accordingly.…”