"Anybody on this list that you're more worried about?" Qualitative analysis exploring the functions of questions during end of shift handoffs

Colleen M. O'Brien, Mindy E. Flanagan, Alicia A. Bergman, Patricia R. Ebright, Richard Frankel

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective: To investigate questions and the functions they serve in nursing and medicine handoffs. Research: design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Subjects: Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results: Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions: Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.

Original languageEnglish (US)
Pages (from-to)76-83
Number of pages8
JournalBMJ Quality and Safety
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Nurses
Patient Handoff
Checklist
Nursing
Research Design
Medicine
Delivery of Health Care
Safety

ASJC Scopus subject areas

  • Health Policy

Cite this

"Anybody on this list that you're more worried about?" Qualitative analysis exploring the functions of questions during end of shift handoffs. / O'Brien, Colleen M.; Flanagan, Mindy E.; Bergman, Alicia A.; Ebright, Patricia R.; Frankel, Richard.

In: BMJ Quality and Safety, Vol. 25, No. 2, 01.02.2016, p. 76-83.

Research output: Contribution to journalArticle

O'Brien, Colleen M. ; Flanagan, Mindy E. ; Bergman, Alicia A. ; Ebright, Patricia R. ; Frankel, Richard. / "Anybody on this list that you're more worried about?" Qualitative analysis exploring the functions of questions during end of shift handoffs. In: BMJ Quality and Safety. 2016 ; Vol. 25, No. 2. pp. 76-83.
@article{924c033709d240708384e3d73714fe35,
title = "{"}Anybody on this list that you're more worried about?{"} Qualitative analysis exploring the functions of questions during end of shift handoffs",
abstract = "Background: Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective: To investigate questions and the functions they serve in nursing and medicine handoffs. Research: design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Subjects: Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results: Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions: Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.",
author = "O'Brien, {Colleen M.} and Flanagan, {Mindy E.} and Bergman, {Alicia A.} and Ebright, {Patricia R.} and Richard Frankel",
year = "2016",
month = "2",
day = "1",
doi = "10.1136/bmjqs-2014-003853",
language = "English (US)",
volume = "25",
pages = "76--83",
journal = "BMJ Quality and Safety",
issn = "2044-5415",
publisher = "BMJ Publishing Group",
number = "2",

}

TY - JOUR

T1 - "Anybody on this list that you're more worried about?" Qualitative analysis exploring the functions of questions during end of shift handoffs

AU - O'Brien, Colleen M.

AU - Flanagan, Mindy E.

AU - Bergman, Alicia A.

AU - Ebright, Patricia R.

AU - Frankel, Richard

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background: Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective: To investigate questions and the functions they serve in nursing and medicine handoffs. Research: design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Subjects: Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results: Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions: Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.

AB - Background: Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective: To investigate questions and the functions they serve in nursing and medicine handoffs. Research: design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Subjects: Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results: Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions: Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.

UR - http://www.scopus.com/inward/record.url?scp=84955303711&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955303711&partnerID=8YFLogxK

U2 - 10.1136/bmjqs-2014-003853

DO - 10.1136/bmjqs-2014-003853

M3 - Article

C2 - 26217038

AN - SCOPUS:84955303711

VL - 25

SP - 76

EP - 83

JO - BMJ Quality and Safety

JF - BMJ Quality and Safety

SN - 2044-5415

IS - 2

ER -