Passing the Baton: A Grounded Practical Theory of Handoff Communication Between Multidisciplinary Providers in Two Department of Veterans Affairs Outpatient Settings
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Handoffs are communication processes that enact the transfer of responsibility between providers across clinical settings. Prior research on handoff communication has focused on inpatient settings between provider teams and has emphasized patient safety. This study examines handoff communication within multidisciplinary provider teams in two outpatient settings.
To conduct an exploratory study that describes handoff communication among multidisciplinary providers, to develop a theory-driven descriptive framework for outpatient handoffs, and to evaluate the strengths and weaknesses of different handoff types.
DESIGN & SETTING
Qualitative, in-depth, semi-structured interviews with 31 primary care, mental health, and social work providers in two Department of Veterans Affairs (VA) Medical Center outpatient clinics.
Audio-recorded interviews were transcribed and analyzed using Grounded Practical Theory to develop a theoretical model of and a descriptive framework for handoff communication among multidisciplinary providers.
Multidisciplinary providers reported that handoff decisions across settings were made spontaneously and without clear guidelines. Two situated values, clinic efficiency and patient-centeredness, shaped multidisciplinary providers’ handoff decisions. Providers reported three handoff techniques along a continuum: the electronic handoff, which was the most clinically efficient; the provider-to-provider handoff, which balanced clinic efficiency and patient-centeredness; and the collaborative handoff, which was the most patient-centered. Providers described handoff choice as a practical response to manage constituent features of clinic efficiency (time, space, medium of communication) and patient-centeredness (information continuity, management continuity, relational continuity, and social interaction). We present a theoretical and descriptive framework to help providers evaluate differential handoff use, reflect on situated values guiding clinic communication, and guide future research.
Handoff communication reflected multidisciplinary providers’ efforts to balance clinic efficiency with patient-centeredness within the constraints of day-to-day clinical practice. Evaluating the strengths and weaknesses among alternative handoff options may enhance multidisciplinary provider handoff decision-making and may contribute to increased coordination and continuity of care across outpatient settings.
KEY WORDShandoff communication outpatient care decision making coordination of care continuity of care patient-centeredness clinic efficiency
We would like to thank the SFVAMC primary care providers, mental health providers, and social workers that took time to participate in this study. We also thank Dr. Lucile Burgo, Dr. John Chardos, Dr. Brad Felker, Dr. Drew Helmer, and Dr. Steve Hunt for their feedback on the interview guide. We extend a special thanks to Drs. Robert Craig, Karen Tracy, and Daniel Dohan for their theoretical counsel. Finally, we acknowledge and thank all Iraq and Afghanistan veterans for their service to our country.
Department of Defense awards W81XWH-08-2-0072 and W81XWH-08-2-0106 funded this study. The funders had no role in the design, data analysis, writing or approval of the manuscript.
A version of this article was presented orally at the annual meeting of the International Society of Traumatic Stress Studies in November, 2011.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.Patterson ES, Wears RL. Patient handoffs: Standardized and reliable measurement tools remain elusive. Joint Comm J Qual Patient Saf. 2010;36(2):52–61.Google Scholar
- 9.McDonald KM, Sundaram V, Bravata DM. Care coordination. In: Shojania KG, McDonald KM, Watcher RM, Owens DK, editors. Closing the quality gap: A critical analysis of quality improvement strategies. Agency for Healthcare Research and Quality: Stanford Univesity-UCSF Evidence-based Practice Center; 2007Google Scholar
- 18.Manser T, Foster S, Gisin S, Jaeckel D, Ummenhofer W. Assessing the quality of patient handoffs at care transitions. Quality & Safety in Health Care. 2010;19(6).Google Scholar
- 30.Bryant A, Charmaz K, eds. The Sage Handbook of Grounded Theory. Thousand Oaks: Sage; 2007.Google Scholar
- 35.Bolton G. Reflective Practice: Writing and Professional Development. Thousand Oaks, CA: Sage; 2001.Google Scholar
- 38.Cohen BE, Gima K, Bertenthal D, Kim S, Marmar CR, Seal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med. 2009. Epub 2009/09/30.Google Scholar
- 42.Seal KH, Cohen BE, Metzler TJ, Gima K, Bertenthal D, Maguen S, et al. Mental health services utilization at VA facilities among Iraq and Afghanistan Veterans in the first year of receiving mental health diagnoses. J Trauma Stress. in press.Google Scholar
- 46.Kvale S, Brinkmann S. InterViews: Learning the Craft of Qualitative Research Interviewing. 2nd ed. Thousand Oaks: Sage; 2009.Google Scholar
- 48.Miles M, Huberman M. Qualitative Data Analysis. 2nd ed. Thousand Oaks: Sage; 1994.Google Scholar
- 51.Muhr T. Atlas.ti. 61st ed. Berlin: Scientific Software Development GmbH; 1993.Google Scholar
- 52.Crabtree B, Miller M, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks: Sage; 1999.Google Scholar
- 53.Have Pt. Doing Conversation Analysis: A practical guide. Thousand Oaks: Sage; 1999.Google Scholar
- 54.Charmaz K. Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, CA: Sage; 2006.Google Scholar
- 61.Goffman E. Interaction Ritual: Essays on Face-to-Face Behavior. New York: Pantheon Books; 1967.Google Scholar