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AMIA Annu Symp Proc. 2012; 2012: 5–7.
Published online 2012 Nov 3.
PMCID: PMC3540522

Electronic Tools for Cognitive Support During Resident Handoffs: State of the Practice and Future Directions

Karen Dunn Lopez, PhD, MPH, RN,1 Vineet Arora, MD, MPP,2 Andrew Johnson, PhD,3 Andrew D. Boyd, MD,4 Gail M. Keenan, PhD, RN,1 and Diana Wilkie, PhD, RN, FAAN1
Author information Copyright and License information Disclaimer

Abstract

In the years following reduced resident work hours, single resident accountability for patient care has disappeared and replaced by frequent care transitions and shared responsibility between residents as the necessary paradigm for delivery of care in acute care settings. With this change, there has been increasing patient acuity and complexity as well as increased cognitive demands for clinicians, potential for miscommunication at care transitions, and preventable errors. Importantly, forgetting to transmit needed information during handoffs is a major contribution to overall suboptimal care processes including: delays in diagnosis and treatment, task omissions, work redundancies and near misses. To address these quality and safety problems, electronic tools embedded in the electronic health record are beginning to emerge. These tools when designed to provide cognitive support for intradisciplinary sharing of care can play a role in reducing information overload, miscommunication, and omission of patient care tasks. Less common are electronic tools that are designed for interdisciplinary information sharing. These interdisciplinary tools have greater potential for decreasing system inefficiencies and improving the overall quality of care delivery than intra-disciplinary tools. This presentation will provide an overview of existing electronic handoff tools and the design implications for future tools.

Description

This presentation will provide an overview of resident handoff literature, key electronic tool design principles, and existing electronic tools for resident handoffs. Tool screen shots and demonstration of interactive prototypes for selected tools will be presented as data visualization examples. Strengths and weaknesses of the existing tools will be discussed. This will lead to substantive discussion of the need for additional information sharing interdisciplinary electronic tools.

We will also present work with which our multidisciplinary team of nurses, physicians, and computer scientists1 has been engaged to further develop an interface for interdisciplinary information sharing. This interface will include: patient care needs, goals, interventions provided, progress toward meeting goals, and tasks that need to be done in the next shift. The long term goal of this research is to provide a framework for the electronic health records (EHRs) that provides a highly useable platform for the integration of key patient data for all clinicians to complete their discipline specific work.

Outline of Presentation

  1. Overview of resident hand off research literature2–4
    1. Hand off definition and goals
    2. Information needs
    3. Error potential
  2. Overview of key design principles5–7
    1. Computer supported collaborative work tools
    2. Cooperative task management
    3. Human Computer Interface
    4. Data visualization
    5. Human factors
    6. User centered design
    7. Interoperability
  3. III. Review of existing electronic hand off tools
    1. Patient Hand-off Tool8,9
    2. UW cores10
    3. VA Physician Hand off Tool11
    4. SynopSIS12
    5. LPCH sign out13
  4. IV. Overall critique and best practices for electronic hand off tools
  5. IV. Future Directions
    1. Interdisciplinary information exchange 14–18
    2. Common data elements_ENREF_9_ENREF_9
    3. Needed features
      1. Patient listing options
      2. Task Lists
      3. Flexibility

Educational Goals

  • The learner will describe problems in patient care quality associated with increased resident care transitions.
  • The learner will identify strengths and weaknesses in existing electronic tools for resident handoffs.
  • The learner will discuss the potential benefits of interdisciplinary electronic tools.
  • The learner will identify design strategies for design of future electronic hand-off tools.

Who should attend

Physicians

Nurses

Residency directors

Interface Designers

Chief Medical Informatics Officers

Chief Nursing Informatics Officers

Handoff domain experts

References

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Articles from AMIA Annual Symposium Proceedings are provided here courtesy of American Medical Informatics Association