Impact of an electronic handoff documentation tool on team shared mental models in pediatric critical care

Abstract

Objective To examine the impact of the implementation of an electronic handoff tool (the Handoff Tool) on shared mental models (SMM) within patient care teams as measured by content overlap and discrepancies in verbal handoff presentations given by different clinicians caring for the same patient. Materials and Methods Researchers observed, recorded, and transcribed verbal handoffs given by different members of patient care teams in a pediatric intensive care unit. The transcripts were qualitatively coded and analyzed for content overlap scores and the number of discrepancies in handoffs of different team members before and after the implementation of the tool. Results Content overlap scores did not change post-implementation. The average number of discrepancies nearly doubled following the implementation (from 0.76 discrepancies per handoff group pre-implementation to 1.17 discrepancies per handoff group post-implementation); however, this change was not statistically significant (p = 0.37). Discrepancies classified as related to dosage of treatment or procedure and to patients’ symptoms increased in frequency post-implementation. Discussion The results suggest that the Handoff Tool did not have the desired positive impact on SMM within patient care teams. Future electronic tools for facilitating team handoff may need longer implementation times, complementary changes to handoff process and structure, and improved designs that integrate a common core of shared information with discipline-specific records. Conclusion While electronic handoff tools provide great opportunities to improve communication and facilitate the formation of shared mental models within patient care teams, further work is necessary to realize their full potential.

Novel displays of patient information in critical care settings: a systematic review

“…20,21,[23][24][25][27][28][29][30][31][33][34][35][36][37][38][39][40][41] All but 1 study had high (!75% of the participants) outcome follow-up. [19][20][21][23][24][25][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Seventeen of the studies had truly or somewhat representative sample groups. 20,21,[23][24][25][27][28][29][30][31][33][34]...…”

“…Seventeen studies were conducted in ICUs, 4 studies were carried out in operating rooms, and 1 study investigated response to critical care events in general hospital wards. Study designs included 14 pre-post studies, [19][20][21][22][23][24][25][26][27][28][29][30][31][32] 5 randomized controlled trials (RCTs), [33][34][35][36][37] and 3 cohort studies. [38][39][40] All studies compared an information display intervention to usual care.…”

“…Study duration ranged from 2 to 48 months. Primary outcomes included user satisfaction, 26 provider efficiency (eg, time to complete tasks), 20,[36][37][38][39] process outcomes, 20,21,25,27,30,32,36,40 patient outcomes, [23][24][25]28,29,31,[33][34][35]38,39 and cost (Figure 2 and Table 3). 19,22…”

“…[19][20][21][23][24][25][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Seventeen of the studies had truly or somewhat representative sample groups. 20,21,[23][24][25][27][28][29][30][31][33][34][35][36][37]40,41 Fourteen of the studies assessed the outcome in an objective manner. [19][20][21][23][24][25]28,29,33,36,[38][39][40][41] ...…”

Measuring situation awareness and team effectiveness in pediatric acute care by using the situation global assessment technique

“…Patient care in clinical settings is most often the result of a team effort as opposed to individual actions, e.g., technical skills, that can be assessed during skills stations. Studies conducted in both health and non-health care settings suggest that shared mental models (SMM) can help enhance team coordination and effectiveness [21, 28–30]. Furthermore, the degree to which team members share team mental models has been shown to correlate with team performance [24].…”