The Influence of Information Technology on Multi-Professional Communication During a Patient Handoff

Little is known about the communication principles necessary for the design and implementation of health information technology (HIT) that supports the needs of healthcare providers from multiple professions. The purpose of this descriptive, exploratory research was to examine the patterns and methods of communication used by nurses, physicians, social workers, respiratory therapists, and pharmacists to share patient information during a patient handoff between units. The principles of complexity science were used as a theoretical framework and an original model of the healthcare organization consisting of embedded complex adaptive systems is presented. Five patient handoffs from the emergency department to participating inpatient units were included in the study. Providers responsible for the care of patients during the designated handoffs were identified through observation and snowball sampling and asked to complete a survey asking whom they communicated with and how. Social Network Analysis was used to map, analyze, and compare the communication patterns used by healthcare providers. Inferential statistics and thematic content analysis were used to examine provider characteristics and satisfaction with the quality of information available. The multi-professional collaborative patterns that emerged revealed the simultaneous use of both synchronous and asynchronous communication methods. HIT was shown to play a major role in the coordination process. Centrality and centralization measures identified that there is no one particular professional group dominating communication and hierarchy metrics indicate a unidirectional communication flow with tiers of dominant providers filtering information to providers on the lower tiers. These patterns suggest that the coordination of patient care during a handoff is a complex process that is the domain of more than one professional group. Satisfaction with the quality of available information was higher for providers working in the ED compared to the admitting units. Verbal communication was preferred by most participants despite difficulties identifying or contacting providers in other units. This study provides a foundation for future research that examines how communication principles that reflect the needs of multiple providers can be incorporated into healthcare provider workflow and HIT design.