Yiu Stella H, Yeung Marianne, Cheung Warren, Kwok Edmund, Mann Gurraman, Williams Allison, Frank Jason R
Department of Emergency Medicine The Ottawa Hospital Ottawa Ontario Canada.
Faculty of Medicine, University of Ottawa Ottawa Ontario Canada.
AEM Educ Train. 2025 Jul 30;9(4):e70087. doi: 10.1002/aet2.70087. eCollection 2025 Aug.
Clinical handover (or handoff), the transfer of patient care between providers, is essential in Emergency Medicine. Poor communication during handover can threaten patient safety. Existing literature views handover as an information transfer; little research has examined the human interaction within handover and how it affects patient safety. We sought a more nuanced understanding of handover to improve this critical aspect of Emergency Medicine care.
We used constructivist grounded theory to explore handover as a social phenomenon. We invited staff emergency physicians in an academic, tertiary care hospital to participate in semi-structured interviews, which were recorded, de-identified, and transcribed. The research team analyzed the transcripts in multiple progressively interpretive analytical stages: initial, focused, and theoretical. Cultural-Historical Activity Theory (CHAT) provided a framework for our data analysis. CHAT situates an individual's action into an activity system in which components interact, producing tensions. We sought to attain theoretical sufficiency by revising the interview guide and recruiting participants for specific insights.
We interviewed sixteen (16) participants. During handover, the object was for the incoming physician (IP) to accept the handover plan from the outgoing physician (OP). We identified a rule requiring minimal handover plans that were realistic and dichotomous. The divisions of labor were tasks. During the interaction, emotional reactions such as judgment or compassion, and behavioral reactions such as pushback or acceptance could have resulted. There were unintended consequences from the handover process that impacted members' self-worth and generated threats to patient safety.
We built a novel and more nuanced framework of handover in the emergency department that involves multiple interactions and tensions. Using this new model, emergency departments should adjust their handover processes to enhance group dynamics and patient safety.
临床交接班（或交接），即医护人员之间患者护理的转移，在急诊医学中至关重要。交接班期间沟通不畅会威胁患者安全。现有文献将交接班视为信息传递；很少有研究探讨交接班中的人际互动及其对患者安全的影响。我们试图更细致入微地理解交接班，以改善急诊医疗护理这一关键环节。
我们运用建构主义扎根理论将交接班作为一种社会现象进行探索。我们邀请了一家学术性三级医院的急诊科医生参与半结构化访谈，访谈进行了录音、去识别化处理并转录。研究团队在多个逐步深入的分析阶段对转录文本进行分析：初始阶段、聚焦阶段和理论阶段。文化历史活动理论（CHAT）为我们的数据分析提供了框架。CHAT将个体的行动置于一个活动系统中，其中各组成部分相互作用，产生张力。我们试图通过修订访谈指南并招募参与者以获取特定见解来实现理论饱和。
我们采访了16名参与者。在交接班期间，目标是接班医生（IP）接受交班医生（OP）的交班计划。我们确定了一条规则，要求交班计划尽量精简、切实可行且具有二分性。劳动分工就是各项任务。在互动过程中，可能会产生诸如评判或同情等情绪反应，以及诸如反驳或接受等行为反应。交接班过程产生了意外后果，影响了成员的自我价值感，并对患者安全构成威胁。
我们构建了一个新颖且更细致入微的急诊科交接班框架，该框架涉及多种互动和张力。运用这一新模式，急诊科应调整其交接班流程，以增强团队活力和患者安全。
