Collaborating—or “Selling” Patients? A Conceptual Framework for Emergency Department–to-Inpatient Handoff Negotiations

Hilligoss, Brian; Mansfield, Jerry A.; Patterson, Emily S.; Moffatt-Bruce, Susan D.

doi:10.1016/s1553-7250(15)41019-0

Cited by 15 publications

(15 citation statements)

References 29 publications

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“…Hilligoss and Cohen (), in studying transfers from the ED, acknowledged the larger cultural context in which handoffs occur, citing such factors as power dynamics and a lack of established relationships among those sending and receiving patients. That work is further developed into a conceptual framework that places handoff interactions into the larger context of negotiation, structural, and macro systems issues (Hilligoss, Mansfield, Patterson, & Moffatt‐Bruce, ).…”

Section: Introductionmentioning

confidence: 99%

A taxonomy and cultural analysis of intra‐hospital patient transfers

Rosenberg

Britton

Feder

et al. 2018

Research in Nursing & Health

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Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra-hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra-hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff.

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Section: Introductionmentioning

confidence: 99%

A taxonomy and cultural analysis of intra‐hospital patient transfers

Rosenberg

Britton

Feder

et al. 2018

Research in Nursing & Health

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“…This study—along with the parent study—builds on the existing literature that had focused on transfers and communication between only‐physicians (Detsky et al, ; Hilligoss et al, ) or between only‐nurses (Shields, Overstreet, & Krau, ) by incorporating diverse stakeholder perspectives from across the transfer process. This study continues to expand the scope of intra‐hospital transfer literature, which has narrowly focused on failures in communication (Ong et al, ; Patterson & Wears, ), by considering the roles of other factors, including patient flow policies and relationships.…”

Section: Discussionmentioning

confidence: 99%

“…This study sought to understand and characterize the multidisciplinary staff experience of cooperation and conflict during intrahospital transfers. The directed content analysis generated three themes: (a) patient flow policies created imbalances of power; This study-along with the parent study-builds on the existing literature that had focused on transfers and communication between only-physicians (Detsky et al, 2015;Hilligoss et al, 2015) or between only-nurses (Shields, Overstreet, & Krau, 2015) by incorporating diverse stakeholder perspectives from across the transfer process. This study continues to expand the scope of intra-hospital transfer literature, which has narrowly focused on failures in communication (Ong et al, 2011;Patterson & Wears, 2010), by considering the roles of other factors, including patient flow policies and relationships.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, in 2009, the Joint Commission Center for Transforming Healthcare (2018; a group of leading hospitals and health systems in the United States) identified improving transfer communication between individuals in different care settings as a targeted initiative. There is a growing body of literature on transfers between providers on different units in a single hospital (Cohen & Hilligoss, 2010;Detsky, Ailon, Weinerman, Amaral, & Bell, 2015;Hilligoss & Cohen, 2013;Hilligoss, Mansfield, Patterson, & Moffatt-Bruce, 2015;Lyons, Arora, & Farnon, 2016;Ong & Coiera, 2011). Much of this literature is limited to transfers of care between providers of the same profession (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Cooperation and conflict in intra‐hospital transfers: A qualitative analysis

et al. 2019

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Aim The purpose of this study was to explore the latent conditions of cooperation and conflict in intra‐hospital patient transfers (i.e. transfers of patients between units in a hospital). Design Secondary qualitative analysis of 28 interviews conducted with 29 hospital staff, including physicians (N = 13), nurses (N = 10) and support staff (N = 6) from a single, large academic tertiary hospital in the Northeastern United States. Methods A two‐member multidisciplinary team applied a directed content analysis approach to data collected from semi‐structured interviews. Results Three recurrent themes were generated: (a) patient flow policies created imbalances of power; (b) relationships were helpful to facilitate safe transfers; and (c) method of admission order communication was a source of disagreement. Hospital quality improvement efforts could benefit from a teaming approach to minimize unintentional power imbalances and optimize communicative relationships between units.

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“…Current handover tools which have largely been designed in the context of hospital wards may not be suitable for the ED environment. Finally, patient movement from the ED to the wards is a frequent occurrence (Sujan et al, 2015) involving multiple interactions between different clinicians across different disciplines and specialties (Hilligoss, Mansfield, Patterson, & Moffatt-Bruce, 2015). ED staff work under time pressure and ED length of stay targets that can result in rushed care transitions and handovers (Nugus & Braithwaite, 2010).…”

Section: Introductionmentioning

confidence: 99%