Objective This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. Background Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. Method We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. Results Participants described three team cognition functions in handoffs—(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition ( p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. Conclusion Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.
Abstract : Four outpatient surgery centers from a large Midwestern community participated in this study assessing the impact of an intervention-aimed at improving the collection of patients' pre-operative clinical information-on both the patients' clinical outcomes and staffs' quality of working life. As part of this study the investigators developed a patient telephone survey to assess the incidence of common or undesirable postoperative symptoms and how they were subsequently managed. This survey was adapted from instruments developed in previous work in outpatient follow-up and anesthesiology. In addition to symptom assessment and management, the investigators were interested in determining how participants rated their medication teaching, pre-operative preparation, and postoperative education. The investigators recruited patients to participate in this study who had ophthalmic, open-joint, otolaryngological (ear, nose, and throat), or intra-/extra-abdominal surgery. The investigators contacted the participants via telephone at least 7 days after surgery and asked them a series of questions about symptoms they experienced, how they managed these symptoms, and the education they received. This paper will detail the development and content of the patient survey.
Department of Anesthesiology, Case Western Reserve Medical School and University Hospitals, Cleveland, Ohio; Cleveland Clinic Foundation, Cleveland, Ohio; Monmouth Medical Center, Long Branch, New Jersey; Northwestern University, Chicago, Illinois, and University of Wisconsin, Madison, Wisconsin
