Department of Biomedical Informatics

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Coordinating Mental Models in Transitions of Care in Critical Care Medicine

Research Topic: 
Clinical Informatics

Patient handoff is a vital communication event that has increasingly been the subject of scrutiny. Poor communication is a frequent cause of suboptimal care, clinical errors, and sentinel events. Intensive care settings are characterized by a high level of urgency, high velocity tempos, and enormous volumes of patient information. As in other settings, handoff communication is used to establish common ground among team members via periodic (daily or twice daily) dyadic conversations and through shared documentation. We have conducted studies of handoff in two clinical care settings: a cardio-thoracic intensive care unit (CTICU) and a pediatric intensive care unit (PICU). We employ a mixed quantitative/qualitative data collection strategy. The data sources included: workflow analysis, shadowing of clinicians, audio recording of handoff and other communication events, interviews with key informants, and document analysis. In addition, the PICU study used a pre-post design to examine the effects of introducing an electronic handoff document on patterns of communication and coordination of clinical care. A focus of our work pertains to shared understanding between different patient care providers and the mediating effect of the EHR on coordination of clinical care.