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"Do You Know What I Know?": How Communication Norms and Recipient Design Shape the Content and Effectiveness of
Nicholas A Rattray1,2,3, Mindy E Flanagan4, Laura G Militello5
1VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA. nrattray@iupui.edu.
Journal of General Internal Medicine
|December 12, 2018
Summary
Physician handoffs are complex, context-sensitive interactions, not just data transfers. Tailoring information based on perceived needs and risks is crucial for patient safety and effective care transitions.
Area of Science:
- Medical communication
- Patient safety
- Healthcare quality
Background:
- Poor end-of-shift handoffs pose safety risks and patient harm.
- Handoffs are complex interactions influenced by social norms and mental frameworks, not just one-way information transfer.
Purpose of the Study:
- Investigate communication strategies used by resident physicians during face-to-face handoffs.
- Understand how residents tailor information based on inferred patient needs and potential harm.
Main Methods:
- Qualitative study involving 35 resident physicians from Medicine and Surgery at three VA Medical Centers.
- Semi-structured cognitive task interviews using audio recordings.
Main Results:
- Handoff effectiveness depends on receiver characteristics, shift type, and patient acuity.
- Information shared is influenced by perceptions of the incoming resident and patient's condition.
- Night shift handoffs include more medical history and care plan details than day shifts.
Conclusions:
- Handoff communication is a socio-technical process balancing relational factors with content and risk.
- Communication is context-sensitive and variable, termed 'recipient design,' not purely mechanistic.
- Interventions should address implicit judgments in handoffs and promote explicit communication competencies.