Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 224 Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210, USA.
Soc Sci Med. 2014 Feb;102:119-28. doi: 10.1016/j.socscimed.2013.11.034. Epub 2013 Nov 28.
This paper reports a discourse analysis of the language doctors used as they talked about and engaged in patient handoffs between the emergency department (ED) and various inpatient services at one highly specialized academic tertiary teaching and referral hospital in the Midwest United States. Although interest in handoff improvement has grown considerably in recent years, progress has been hampered, perhaps in part, because of a widely used but limiting conceptual model of handoff as an information transmission. The purpose of the study reported here is to analyze the way doctors make sense of handoff interactions, including uncovering the interpretive frames they use, in order to provide empirical findings to expand conceptual models of handoff. All data reported were drawn from a two-year ethnographic study (2009-2011) and include semi-structured interviews (n = 48), non-participant observations (349 h), and recorded telephone handoff conversations (n = 48). A total of eighty-six individuals participated, including resident and attending doctors from the ED, internal medicine and surgical services, as well as hospital administrators. Findings are organized around four metaphors doctors used: sales, sports and games, packaging, and teamwork. Each metaphor, in turn, reveals an underlying interpretive frame that appears to be influenced by organizational and social structures and to shape the possibilities for action that doctors perceive. The four underlying interpretive frames are: handoff as persuasion, handoff as competition, handoff as expectation matching, and handoff as collaboration. Taken together, these interpretive frames highlight the complex, socially interactive nature of handoff and provide an empirical basis for grounding and enriching the conceptual model of handoff that guides research and practice improvement efforts.
本文报告了对美国中西部一家高度专业化的学术三级教学和转诊医院的急诊部 (ED) 与各种住院服务之间进行患者交接时医生所用语言的话语分析。尽管近年来对手册交接改进的兴趣大大增加，但进展却受到了阻碍，部分原因可能是因为广泛使用但限制了对手册交接作为信息传递的概念模型。这里报告的研究目的是分析医生理解交接互动的方式，包括揭示他们使用的解释框架，以便提供扩展交接概念模型的经验发现。本文报告的所有数据均来自为期两年的民族志研究（2009-2011 年），包括半结构化访谈（n=48）、非参与式观察（349 小时）和记录的电话交接对话（n=48）。共有 86 人参与，包括来自急诊部、内科和外科服务以及医院管理人员的住院医生和主治医生。研究结果围绕医生使用的四个隐喻组织：销售、体育和游戏、包装和团队合作。每个隐喻反过来都揭示了一个潜在的解释框架，这些框架似乎受到组织和社会结构的影响，并塑造了医生感知的行动可能性。四个潜在的解释框架是：交接作为说服、交接作为竞争、交接作为期望匹配和交接作为协作。这些解释框架共同强调了交接的复杂、社会互动性质，并为指导研究和实践改进努力的交接概念模型提供了实证基础。
