Abstract
Handover between colleagues is a complex task. The problem is that handovers are often inadequate because they are not structured according to theoretically grounded guidelines. Based on the cognitive load theory, we suggest that allowing a clarifying dialogue and thereby optimizing germane cognitive load enhances the information quality and diagnostic accuracy at handover, but may prolong handover duration. We also expect that mentioning key information first and thus decreasing intrinsic cognitive load improves information quality and diagnostic accuracy. We developed two representative paediatric cases for presentation in a factorial 2 × 2 design. Sixth-year medical students (N = 80) were randomly assigned to one of four groups that differed with regard to how the case histories were delivered to them (chronological order versus key information mentioned first) and direction of information exchange (unidirectional versus a clarifying dialogue). The receivers of the handover were asked to write a report of the cases and suggest the best diagnosis. Dependent variables were information quality of the written report (Information score), quality of the diagnosis (Diagnostic accuracy score) and the time it took to deliver the written handover case report (Handover report duration). Seen through the lens of cognitive load theory, allowing a clarifying dialogue at handover, and thus optimizing the germane cognitive load, significantly increased the Information score (p < 0.0005), Diagnostic accuracy score (< 0.05) and Handover report duration (p < 0.001).
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Acknowledgements
Consultant Martin Boxill is thanked for comments on Cases A and B.
Consultant Mads Skipper, consultant Jens Peter Nielsen and registrar Anne Sofie S. Jørgensen are thanked for scoring of information quality.
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Appendices
Appendix 1
After randomisation, text information on cases A and B was reported verbally and individually to the participants. The information was provided verbally in Danish by authors TB or HA.
Case A
Group Terms | Text reported verbally to each participant |
|---|---|
CHR-UNI Chronological report No dialogue | This boy was born 3 weeks preterm, had a birthweight of 2900 gs, was jaundiced for a short period and is now 5 months old. He was feeding and developing well. He had been able to hold his head, but now this is difficult, and he does not roll over yet. He has had a series of body bending-over events with crying. He is now admitted to the department of paediatrics. The nurses observed a number of events with flexion of the body and extension of the arms. Head lag is seen on the traction manoeuvre |
CHR-DIA Chronological report Dialogue | |
KEY-UNI Three key data items first No dialogue | A 5-month-old boy with series of bending-over events He was born 3 weeks preterm, had a birthweight of 2900 grams and had jaundice for a short period. He was feeding and developing well. He had been able to hold his head, but now this is difficult and he does not roll over yet. He has now on the paediatrics ward. The nurses observed a number of events with flexion of the body and extension of the arms. Head lag is seen on the traction manoeuvre |
KEY-DIA Three key data items first Dialogue |
Case B
Group Terms | Text reported verbally to each participant |
|---|---|
CHR-UNI Chronological report No dialogue | At age 2 weeks this girl was admitted due to a RS virus infection. She was is re-admitted at age 6 years. Yesterday she was playing in hay and noted a pain in her left knee. On examination, she is ambulant, not neck stiff and the knee is not swollen. BP is 100/70, pulse 113 and temperature 37.6 °C. Large blue haematomas on the legs. The platelet-count is 47 × 109 (165–435). Haemoglobin is 4.1 mmol/l (6.5–8.9) |
CHR-DIA Chronological report Dialogue | |
KEY-UNI Three key data items first No dialogue | A 6-year-old girl is admitted with large blue bruises on the legs At age 2 weeks this girl was admitted due to a RS virus infection. Yesterday she was playing in hay and noted a pain in her left knee. On examination, she is ambulant, not neck stiff and the knee is not swollen. BP is 100/70, pulse 113 and temperature 37.6 °C. Large blue haematomas on the legs. The platelet count is 47 × 109 (165–435). Haemoglobin is 4.1 mmol/l (6.5–8.9) |
KEY-DIA Three key data items first Dialogue |
Appendix 2
This is the sheet used for duration of report and for completeness of the information provided with case A. (Adapted from Weiss et al. 2013.)
Relevance of information | Erroneous information | Total Infor-mation score | |||||
|---|---|---|---|---|---|---|---|
Must + 2 | Should + 1 | Neutral 0 | Extraneous − 1 | Severe error − 3 | Mild error − 1 | ||
Duration of report ______min. | – | – | |||||
Information-packages | If reported, please put ring around the number (0, 1 or 2) | In case of an error, please fill in with − 1 or − 3 | |||||
Preterm delivery BW 2900 gram Mild jaundice | 1 1 | 0 | |||||
5 months old Boy | 2 2 | ||||||
Series of events | 2 | ||||||
Feeds well Development normal up to now | 1 1 | ||||||
No longer balancing head Not rolling over | 1 1 | ||||||
Examination: series of events: flexion and crying | 2 | ||||||
Head lag at traction manoeuvre | 1 | ||||||
Sum | |||||||
Reference | 8 | 7 | 0 | /15 | |||
Diagnosis (0, 0.5 or 1.0) | Write here: | ||||||
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Balslev, T., Muijtjens, A., de Grave, W. et al. How isolation of key information and allowing clarifying questions may improve information quality and diagnostic accuracy at case handover in paediatrics. Adv in Health Sci Educ 26, 599–613 (2021). https://doi.org/10.1007/s10459-020-10001-2
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DOI: https://doi.org/10.1007/s10459-020-10001-2