Exploring Emergency Physician–Hospitalist Handoff Interactions: Development of the Handoff Communication Assessment
Received 10 October 2008; received in revised form 5 March 2009, 29 May 2009 and 29 July 2009; accepted 18 September 2009. published online 30 November 2009.
Study objective
We develop and evaluate the Handoff Communication Assessment, using actual handoffs of patient transfers from emergency department to inpatient care.
Methods
This was an observational qualitative study. We derived a Handoff Communication Assessment tool, using categories from discourse coding described in physician-patient communication, previous handoff research in medicine, health communication, and health systems engineering and pilot data from 3 physician-hospitalist handoffs. The resulting tool consists of 2 typologies, content and language form. We applied the tool to a convenience sample of 15 emergency physician-to-hospitalist handoffs occurring at a community teaching hospital. Using discourse analysis, we assigned utterances into categories and determined the frequency of utterances in each category and by physician role.
Results
The tool contains 11 content categories reflecting topics of patient presentation, assessment, and professional environment and 11 language form categories representing information-seeking, information-giving, and information-verifying behaviors. The Handoff Communication Assessment showed good interrater reliability for content (κ=0.71) and language form (κ=0.84). We analyzed 742 utterances, which provided the following preliminary findings: emergency physicians talked more during handoffs (67.7% of all utterances) compared with hospitalists (32.3% of all utterances). Content focused on patient presentation (43.6%), professional environment (36%), and assessment (20.3%). Form was mostly information-giving (90.7%) with periodic information-seeking utterances (8.8%) and rarely information-verifying utterances (0.4%). Questions accounted for less than 10% of all utterances.
Conclusion
We were able to develop and use the Handoff Communication Assessment to analyze content and structure of handoff communication between emergency physicians and hospitalists at a single center. In this preliminary application of the tool, we found that emergency physician–to-hospitalist handoffs primarily consist of information giving and are not geared toward question-and-answer events. This critical exchange may benefit from ongoing analysis and reformulation.
aSchool of Communication, Western Michigan University, Kalamazoo, MI
bCollege of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI
cCollege of Education, Western Michigan University, Kalamazoo, MI
eDepartment of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI
fDepartment of Emergency Medicine, Texas A&M University, College Station, TX
Address for correspondence: Julie Apker, PhD, School of Communication, Western Michigan University, 1903 W Michigan Ave, Kalamazoo, MI 49008-5318; 269-387-3140, fax 269-387-3990
Please see page 162 for the Editor's Capsule Summary of this article.
Author contributions: JA, LAM, and EBA conceived and designed the study, as well as obtained research funding. LAM, SCG, JJH, and RLS provided input on iterations of assessment instrument. NAJ supervised on-site data collection. RLS provided statistical advice. JA and LAM managed the data, analyzed the data, and generated findings. JA drafted the original article and all subsequent iterations. All authors contributed to revisions, with LAM and RLS making substantive contributions to the finalized document. JA takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research study was supported by the Bronson Research Foundation under grant BRF-2007-0021.
Publication date: Available online November 27, 2009.
ABSTRACT