Opportunities for interprofessional input into nurse and physician hand-off communication

Hand-offs are vulnerable times for hospitalized patients. Nurses and physicians routinely engage in hand-off communication but their communications remains siloed. Our objectives were to identify key information from each profession that would be of use to the other's hand-off process, and to identify facilitators and barriers to obtaining that input.

We conducted this qualitative study in a medical intensive care unit. Subjects included 8 physicians, 2 advanced practice providers, and 6 nurses. We conducted observations of hand-offs and afternoon rounds as well as semistructured interviews. We analyzed the transcribed interviews and field note observations\ to identify themes of interest using a grounded theory approach.

Physicians were interested in patient data in context, family dynamics, and changing patient condition. Nurses were interested in details about the plan of care and anticipatory guidance. Facilitators of communication included proximity, face-to-face communication, and the electronic medical record. Barriers were busy schedules, inaccurate data, and negative attitudes.

There are key areas of content that both physicians and nurses would like from the other profession to enhance intensive care unit hand-off communication. Interventions designed to increase interdisciplinary communication should focus on these key areas of content.