“Workin’ on Our Night Moves”

How Residents Prepare for Shift Handoffs

Laura G. Militello, Nicholas A. Rattray, Mindy E. Flanagan, Zamal Franks, Shakaib Rehman, Howard S. Gordon, Paul Barach, Richard Frankel

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Poor-quality handoffs have been associated with serious patient consequences. Researchers and educators have answered the call with efforts to increase system safety and resilience by supporting handoffs using increased communication standardization. The focus on strategies for formalizing the content and delivery of patient handoffs has considerable intuitive appeal; however, broader conceptual framing is required to both improve the process and develop and implement effective measures of handoff quality. Methods: Cognitive task interviews were conducted with internal medicine and surgery residents at three geographically diverse US Department of Veterans Affairs medical centers. Thirty-five residents participated in semi-structured interviews using a recent handoff as a prompt for in-depth discussion of goals, strategies, and information needs. Transcribed interview data were analyzed using thematic analysis. Results: Six cognitive tasks emerged during handoff preparation: (1) communicating status and care plan for each patient; (2) specifying tasks for the incoming night shift; (3) anticipating questions and problems likely to arise during the night shift; (4) streamlining patient care task load for the incoming resident; (5) prioritizing problems by acuity across the patient census, and (6) ensuring accurate and current documentation. Conclusion: Our study advances the understanding of the influence of the cognitive tasks residents engage in as they prepare to hand off patients from day shift to night shift. Cognitive preparation for the handoff includes activities critical to effective coordination yet easily overlooked because they are not readily observable. The cognitive activities identified point to strategies for cognitive support via improved technology, organizational interventions, and enhanced training.

Original languageEnglish (US)
JournalJoint Commission Journal on Quality and Patient Safety
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Interviews
Patient Handoff
Patient Acuity
United States Department of Veterans Affairs
Censuses
Internal Medicine
Documentation
Patient Care
Communication
Research Personnel
Technology
Safety

ASJC Scopus subject areas

  • Leadership and Management

Cite this

“Workin’ on Our Night Moves” : How Residents Prepare for Shift Handoffs. / Militello, Laura G.; Rattray, Nicholas A.; Flanagan, Mindy E.; Franks, Zamal; Rehman, Shakaib; Gordon, Howard S.; Barach, Paul; Frankel, Richard.

In: Joint Commission Journal on Quality and Patient Safety, 01.01.2018.

Research output: Contribution to journalArticle

Militello, Laura G. ; Rattray, Nicholas A. ; Flanagan, Mindy E. ; Franks, Zamal ; Rehman, Shakaib ; Gordon, Howard S. ; Barach, Paul ; Frankel, Richard. / “Workin’ on Our Night Moves” : How Residents Prepare for Shift Handoffs. In: Joint Commission Journal on Quality and Patient Safety. 2018.
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