2017 HSC Section 2 - Practice Management

ARTICLE IN PRESS

Surgery j 2016

Hasan et al

distractions and the handoff reception process and handoff environment ( P > .05) but agreed on the handoff delivery process ( P = .017; Table V ). Com- parison of different participant types (eg, comparing an observer to a receiver or source) showed divergence in responses ( P > .05). Linear regression analysis determined that the handoff delivery process was affected negatively by the number of side discussions ( b = 0.18, P = .046), the number of teaching discussions ( b = 0.42, P = .048), and by extraneous staff entering/leaving the handoff room ( b = 0.35, P = .04). Similarly, the handoff reception process was negatively impacted by the number of side dis- cussions ( b = 0.26, P = .004), the number of teaching discussions ( b = 0.20, P = .044), the presence of active, unrelated electronic devices Table VI. Linear regression analysis of predictors of handoff delivery/reception quality Handoff delivery process b coefficient P value Negative predictors Number of side discussions 0.18 .046 Number of teaching discussions 0.42 .048 Extraneous staff entering/leaving the handoff room 0.35 .040 Positive predictors Source-receiver relationship +0.83 < .001 Handoff reception process Negative predictors Number of side discussions 0.26 .004 Number of teaching discussions 0.20 .044 Presence of electronic devices 0.57 .005 Source-receiver hierarchal barrier 0.31 .002 Positive predictors Source-receiver relationship +0.75 < .001 Table V. Receiver 1 and receiver 2 comparison using ICC ( N = 39) ICC P value Any extraneous staff entering/ exiting room 0.216 NS Background conversation by extraneous staff (Y/N) 0.050 NS Any side conversations by handoff staff 0.027 NS Any unrelated electronic devices on during handoff? 0.257 NS Rate handoff delivery (1–5) 0.234 .017 Rate handoff reception (1–5) 0.089 NS NS , Not significant ( P value > .05).

( b = 0.57, P = .005), and the sense of hierarchy among handoff participants ( b = 0.31, P = .002). The delivery ( b = 0.83, P < .001) and reception ( b = 0.75, P < .001) processes were affected positively by a good relationship between the source and receiver ( Table VI ). DISCUSSION Patient handoffs have become an integral part of patient care. The importance of this communi- cation process has become evident in light of the inception of duty-hour restrictions in 2003; in one study, handoffs increased by 40%. 2 Intuitively, handoffs in patient care present a risk of loss of vi- tal information and, consequently, the potential for adverse patient events. A large body of litera- ture identifies flaws in patient handoffs, with at- tempts to improve this process, 6 but the majority of previous efforts have designed interventions either empirically or based on feedback from focus groups. 7,8 A systematic review of the literature by Abraham et al 1 examined various handoff tools. In this re- view, the majority of studies focused on effective- ness of a tool as well as user satisfaction. Furthermore, the theoretic basis of most studies has been limited to some aspect(s) of the handoff process (eg, information processing, cognition, accountability). An editorial in the Journal of Grad- uate Medical Education describes the magnitude of the handoff problem and proposes a paradigm shift in how research is done to improve handoffs. 5 Specifically, future research is recommended to start with a conceptual framework based on previ- ous research results. This process is exactly what we sought to accomplish with our project. Our group has developed a conceptual framework utilizing communication theory to study the handoff pro- cess, break it down to its core elements, and develop an intervention that targets these various elements. 4 Our study may be the first in the litera- ture that evaluates the handoff process in the context of a comprehensive communication framework. In our study, we evaluated specifically the process of delivering and receiving patient handoffs, not the content of the message being delivered or received. Our study demonstrated that distractions are very common during surgery resident handoffs; 70% of residents providing handoffs reported a distraction, while 66–75% of residents receiving handoffs reported a distraction. According to the observers, an average of 4.7 ± 3.4 distractions occurred per service handoff. Extraneous

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