Documentation Improvement of “Care Path”

It is possible to show the quality of handoffs in LTACH. There have been some pioneering examples of using data from computerized handoff systems to measure frequency of system use. A related technique uses a mixture of computer records and observation to carry out random audits of planned processes or mandated procedures. The epidemiological research style is appropriate to assessing the quality of handoffs, the methodologies for studies of handoff quality tend to be questionnaires, case reports and field observations. The overwhelming majority are reports from one or a few services within one or a few hospitals. As they frequently acknowledge, this raises some barriers for efforts at generalization. The many research reports that have accumulated do not converge on any simple characterization of a good handoff. They highlight pitfalls, advantages and tradeoffs associated with existing handoff methods, or with experimentally implemented procedures, such as bedside nursing report, telephone callback, or computer produced handoff documents.

The studies so far develop and use research methods to inform the design of handoff improvements, but, with only a few exceptions, they do not explicitly evaluate the effectiveness of their methods. The problem of how to assess a process of inquiry aimed at improving handoffs in units, or between pairs of units, is only now coming into focus. Studies of comparable groups of medical professionals using different processes to understand and improve their handoffs could be very valuable. Some insight into effective inquiry methods might be derived from examining the procedures used by software engineers, who often employ systematic approaches to understand the workflow of their clients. Their work is relevant because of the underlying parallels between a unit analysing its definition of a good handoff and software designers need to determine what information should be available at various points in a complex workflow. Indeed, these two worlds meet when physicians or nurses become intensively involved in design of computerized sign-out tools, as is increasingly the. It is encouraging that many of these studies are distinguished by a clear sense that handoff communication involves more than just transmission of information and that good IT design must support the additional functions that handoffs accomplish. Continuing collaborations among physicians, nurses and information system designers appears to have considerable promise for producing both more useful software and improved elicitation of unit level handoff requirements.


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