Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes

Abstract

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.

Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions

“…It has been argued that checklists serve as cognitive aids with particular effects for attentional focus and memory. Moreover, checklist use may alleviate mental demands and facilitate shift of attentional focus away from task, process, and team coordination to ensure all relevant patient information is conveyed in OR-PICU handoff [43]. Our results suggest that our intervention may facilitate mental demands in handover practice and contributing to ease cognitive overload and to facilitate comprehension of the handover situation and task demands [12,23].…”

“…Nonetheless, smooth and effective handovers cannot be exclusively achieved by checklist or standardization interventions [19,53]. Participative process and workflow re-design approaches that address all work system-components and draw upon OR and PICU professionals' by-in are necessary to establish smooth handover processes [43,54].…”

“…Concerning future research, developing a thorough understanding of effective postoperative handovers with deduction of adequate and evidence-based improvement measures in every day clinical practice remains an ongoing challenge to improve pediatric patient safety [7]. Our evaluation and its observational approach were augmented with provider selfreports as a unique and valuable attempt to capture genuine characteristics of handover practices that are not accessible to observations, i.e., cognitive system factors [43]. Nonetheless, future attempts should seek for additional measures to capture and elicit professionals' experiences in situ care complexities.…”

Patient Handoffs and Trainee Perspectives Across an Institution: A Mixed Methods Study Informing Best Practices and an Expanded Conceptual Framework for Handoffs

“…It also emphasizes the danger of assessing trainees without accounting for the permeating health-systems factors that may negatively impact their successes. [32][33][34] Deliberate attention, support, and resources are necessary to address this phenomenon. Otherwise, improvements are unlikely, and it will be di cult to disentangle the impact of faulty systems on trainee performance and patient safety outcomes.…”