VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA.
Department of Anthropology, Indiana University-Purdue University Indianapolis, Indianapolis, USA.
J Gen Intern Med. 2019 Feb;34(2):264-271. doi: 10.1007/s11606-018-4755-5. Epub 2018 Dec 10.
Poor communication during end-of-shift transfers of care (handoffs) is associated with safety risks and patient harm. Despite the common perception that handoffs are largely a one-way transfer of information, researchers have documented that they are complex interactions, guided by implicit social norms and mental frameworks.
We investigated communication strategies that resident physicians report deploying to tailor information during face-to-face handoffs that are often based on their implicit inferences about the perceived information needs and potential harm to patients.
METHODS/PARTICIPANTS: We interviewed 35 residents in Medicine and Surgery wards at three VA Medical Centers (VAMCs).
We conducted qualitative interviews using audio-recorded semi-structured cognitive task interviews.
The effectiveness of handoff communication depends upon three factors: receiver characteristics, type of shift, and patient's condition and perceived acuity. Receiver characteristics, including subjective perceptions about an incoming resident's training or ability levels and their assumed preferences for information (e.g., detailed/comprehensive vs. minimal/"big picture"), influenced content shared during handoffs. Residents handing off to the night team provided more information about patients' medical histories and care plans than residents handing off to the day team, and higher patient acuity merited more detailed information and the medical service(s) involved dictated the types of information conveyed.
We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as "recipient design." Interventions should focus on raising awareness of times when information is omitted, customized, or expanded based on implicit judgments, the emerging threats such judgments pose to patient care and quality, and the competencies needed to be more explicit in handoff interactions.
在交接班过程中沟通不畅与安全风险和患者伤害有关。尽管人们普遍认为交接班主要是信息的单向传递，但研究人员已经记录到，它们是复杂的交互，受到隐含的社会规范和心理框架的指导。
我们调查了住院医师在面对面交接班时报告使用的沟通策略，这些策略通常基于他们对患者感知信息需求和潜在伤害的隐含推断来调整信息。
方法/参与者：我们在三家退伍军人事务医疗中心（VAMC）的内科和外科病房采访了 35 名住院医师。
我们使用带录音的半结构化认知任务访谈进行了定性访谈。
交接班沟通的有效性取决于三个因素：接收者特征、班次类型以及患者的病情和感知的紧急程度。接收者特征，包括对传入住院医师的培训或能力水平的主观感知，以及他们对信息的假设偏好（例如，详细/全面与最小/“大局”），影响了交接班时共享的内容。向夜班团队交班的住院医师比向白班团队交班的住院医师提供了更多关于患者病史和护理计划的信息，而患者的病情严重程度需要更详细的信息，所涉及的医疗服务决定了传达的信息类型。
我们发现，交接班沟通涉及到复杂的社会技术信息组合，住院医师在内容和风险之间平衡关系因素。这不是一个简单地转移临床数据的机械过程，而是基于对沟通习惯的学习，这些习惯是上下文敏感和可变的，我们称之为“接收者设计”。干预措施应重点关注在基于隐含判断省略、定制或扩展信息的情况时提高意识，这些判断对患者护理和质量构成的新威胁，以及在交接班互动中更加明确所需的能力。
