Revealing structures in narratives: A mixed-methods approach to studying interdisciplinary handoff in critical care

Abstract

The proposed novel mixed-methods approach helped to reveal emerging patterns in content and structure of handoff communication and highlight differences due to the clinical context, and to the different priorities of clinicians on interdisciplinary patient care teams. The approach for calculating SMM is more ecologically sensitive as it relies on naturally occurring discourse and less intrusive than traditional ways of assessing SMM, and takes initial steps toward establishing empirical foundation for the design of electronic tools to support handoff in interdisciplinary teams.

The Clinical Engineering–Information Technology Professional Practice Interface

“…29 Comparably, clinical informatics solutions for documentation systems model the broader documentation system via measurements describing the complexity/hierarchy of the documentation task. 30 These clinical informatics solutions address systemlevel clinical actions (such as streamlining computer-based activities 31 or clinical handoff 32 ). Therefore, in seeking to solve problems within the complex information space of medicine, clinical engineering solves subsystem problems addressing specific issues of patient safety (eg, individual cognitive performance processes).…”

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

“…The transcripts were analyzed in a multi-step approach, described extensively in Mamykina et al[41]. First, all handoff transcripts were organized into team handoff groups by their clinical team, date, and time; each group represented a set of verbal handoffs given by different clinicians caring for the same patient during a single transition of care.…”

“…Although Apker’s taxonomy was originally developed for handoffs that occurred as part of patients’ transition from the Emergency Room (ER) to other units in a hospital, it proved to be sufficiently applicable for handoffs in Critical Care Units, including the PICU in this study[41]. However, the taxonomy was modified to account for differences in handoff communication between the ER and PICU and to allow for a more granular classification.…”

“…To address these limitations, we previously introduced a novel method for measuring teams’ SMMs by quantifying the degree of content overlap in verbal handoffs of different clinicians caring for the same patient[41]. We further argued that better aligned teams with richer SMMs have a higher degree of content overlap in their handoffs.…”