An observational study of care transitions of pediatric patients: modeling the work system and team communication in handoffs

Mayes, Emma Elizabeth

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https://hdl.handle.net/2142/115478 Copy

Description

Title

An observational study of care transitions of pediatric patients: modeling the work system and team communication in handoffs

Author(s)

Mayes, Emma Elizabeth

Issue Date

2022-04-25

Director of Research (if dissertation) or Advisor (if thesis)

Wooldridge, Abigail R

Department of Study

Industrial&Enterprise Sys Eng

Discipline

Industrial Engineering

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

M.S.

Degree Level

Thesis

Keyword(s)

• pediatric care transitions
• handoffs
• macroergonomics
• work system
• Systems Engineering Initiative for Patient Safety (SEIPS)
• team cognition
• team communication

Abstract

Care transitions are the transfer of information, authority, and responsibility for a patient. Care transitions also include handoffs, the exchange of information about the patient accompanying either transfer of control or responsibility for a patient between clinicians. Communication breakdown during handoff results in decreased patient safety, so handoffs are important to consider for improvement. The focus of this thesis is on transitions from the operating room (OR) to the pediatric intensive care unit (PICU). The goal was to identify improvements in OR to PICU care transitions through two data collection methods: first, through audio collected during care transitions, and second, through observation notes collected by a human factors observer during the same care transitions. We used these two data streams to triangulate our findings and recommendations. In our first objective, we aimed to understand team communication in care transitions from the OR to the PICU to support team communication in handoffs. We adapted a framework to analyze turns of talk in transcripts of OR to PICU handoffs by speaker affiliation, communication behavior, and communication content through consensus-based coding. We found that PICU team members spoke for approximately 72% of the turns of talk. We also found that professional environment, both as communication behavior and content, accounted for the highest proportion of turns of talk on average. We used cumulative frequency charts to show information giving and assessment behaviors occurred at similar frequency throughout handoff, and found increases in planning and decision-making behaviors towards the end of handoff. In our second objective, we aimed to identify areas for improvement through a barrier and facilitator analysis of the work system. We used independent identification and consensus-based discussion to define dimensions of barriers and facilitators and the proximal and distal work system elements involved in the barriers and facilitators based on the observation notes. We defined nine dimensions of barriers and facilitators: anticipation, attainability of supplies, distraction, explicit coordination, personal protective equipment (PPE) requirements, staffing resources, team cognition, tools and technology, and workspace. We found that organization was the most involved work system proximally and distally in our dimensions, so we proposed that future work investigate measures to mitigate these barriers and support these facilitators through organization-based changes. From our team communication study, we proposed three ideas: 1) develop flexible, team-based handoff protocols, 2) reduce and address late arrivals, and 3) foster a culture of social communications. From our work system barrier and facilitator analysis, we provided six recommendations: 1) technology to transcribe handoff information, 2) the PICU provide support nursing staff, 3) organization foster a culture of awareness, 4) clinicians use closed-loop communication practices, 5) the PICU keep extras of frequently used supplies in the patient room, and 6) the OR team give verbal handoff only when all are unoccupied. Triangulation showed overlap in our two sets of data; we had three prioritized recommendations: 1) technology transcribes verbal handoff to support information verification, 2) the entire care team participates in handoff and in explicit coordination for patient transfer, and 3) organizations prepare the PICU for safe care transitions through early notification before patient arrival and providing adequate PICU support staff to focus on handoff. We advised that our methodology be integrated with a clinical perspective or handoff performance metric to support and evaluate our recommendations in future studies of care transitions.

Graduation Semester

2022-05

Type of Resource

Thesis

Copyright and License Information

Copyright 2022 Emma Mayes

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