Northeastern University, Bouvé College of Health Sciences, School of Nursing, Boston, MA, USA.
Int J Med Inform. 2010 Apr;79(4):252-67. doi: 10.1016/j.ijmedinf.2009.12.005. Epub 2010 Jan 15.
Health information technology has been shown to influence the communication patterns of healthcare providers. The goal of this study was to learn more about how healthcare providers communicate and exchange patient clinical information during patient handoffs (transfers) between units in an acute care setting.
Convenience sampling was used to select five patient handoffs. Questionnaires were distributed to providers identified through observation and snowball sampling. Social network analysis methodology was used to develop sociograms of the emergent communication patterns and identify the role of individual providers in the handoff process based on the number of contacts with other providers and incoming and outgoing communication activity. Individual handoff network size ranged from 11 to 20 providers. Participants were asked to describe the method of communication they used to access or share clinical information with other providers, their preferred method of communication; their satisfaction with the available options; and their suggestions for how the process could be improved.
The network patterns that emerged uncovered the overlapping use of synchronous and asynchronous communication methods (verbally via phone or in person; or written via paper charts and/or an electronic records). No particular professional group dominated or coordinated information flow; instead each handoff network exhibited unique communication patterns and information coordination by two or more influential providers from nursing, medicine, or pharmacy. Most (84%) participants preferred verbal communication. Overall satisfaction with the current communication process varied by unit: 82% of emergency department providers and 54% of the providers working in the admitting units stated they were satisfied or very satisfied. Recommendations for improvement included converting all units to the electronic health record, electronic handoff communication modules and asynchronous multi-professional communication logs.
The results of this exploratory study provide a foundation for future research examining how network structure and communication principles can be used to design health information technology that compliments the non-linear information gathering and dissemination behaviors of providers from multiple professions.
健康信息技术已被证明会影响医疗保健提供者的沟通模式。本研究的目的是更多地了解医疗保健提供者在急性护理环境中各科室之间进行患者交接（转科）时如何进行沟通和交流患者临床信息。
采用便利抽样法选择了 5 例患者交接。通过观察和滚雪球抽样确定了提供者，然后向他们分发了调查问卷。使用社会网络分析方法，根据与其他提供者的联系次数以及传入和传出的交流活动，为交接过程中的每个提供者建立了沟通模式的社会关系图，并确定了他们在交接过程中的角色。单个交接网络的规模从 11 名到 20 名提供者不等。参与者被要求描述他们用来获取或与其他提供者共享临床信息的沟通方法、他们首选的沟通方式、对现有选择的满意度以及他们对改进流程的建议。
出现的网络模式揭示了同步和异步沟通方法（通过电话或当面口头交流；或通过纸质图表和/或电子记录进行书面交流）的重叠使用。没有特定的专业群体主导或协调信息流；相反，每个交接网络都表现出独特的沟通模式和由护理、医学或药学领域的两个或更多有影响力的提供者进行的信息协调。大多数（84%）参与者更喜欢口头沟通。当前沟通流程的整体满意度因科室而异：82%的急诊部门提供者和 54%的入院科室提供者表示满意或非常满意。改进建议包括将所有科室转换为电子病历、电子交接沟通模块和异步多专业沟通日志。
这项探索性研究的结果为未来研究提供了基础，这些研究将考察如何利用网络结构和沟通原则来设计健康信息技术，以补充来自多个专业的提供者的非线性信息收集和传播行为。
