Care transition of trauma patients: Processes with articulation work before and after handoff

Abstract

While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.

Keywords: Care transition; Communication and coordination; Process mapping.

Figure 1.

Flowchart of study methodology.

Figure 2.

Example of data saturation tracking: OR-to-ICU process map

Figure 3.

SEIPS-based process model of OR-to-PICU care transition.

Figure 4.

SEIPS-based process model of OR-to-ICU care transition.

Figure 5.

Survey items, average responses, χ² and frequency of positive responses. Notes: Possible survey responses 1=strongly disagree, 2=disagree, 3=neither, 4=agree, 5=strongly agree. Chi-square critical value for all tests = 11.1143. *denotes significantly different distribution of responses. Positive responses were 1 and 2, after questions F4 and F10 were reverse coded.