Skip to main content
SpringerLink
Log in

Care transitions in the outpatient surgery preoperative process: facilitators and obstacles to information flow and their consequences

  • Original Article
  • Published:
Cognition, Technology & Work Aims and scope Submit manuscript

Abstract

Patient care transitions have been shown to be critical points at which failure as well as recovery from potential failure may occur. The purpose of this research was to identify transitions in patient care and the flow of associated information at different steps in the outpatient surgery preoperative care process and, in turn, attempt to identify breakdowns in the information flow process and their ramifications. A study of one organization’s preoperative process for outpatient surgery was conducted, employing four means of data collection to gather information on preoperative work processes: employee shadowing, patient shadowing, clinic observation, and dictated feedback. Various facilitators and obstacles in information flow were found to be present in the preoperative care process. Obstacles often resulted in negative consequences for healthcare providers and patients. Helping care providers understand how their actions affect the various elements of the preoperative process, through improved awareness, may be one way to improve information flow problems within the outpatient surgery process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Baskerville P (2006) A new vision for day surgery. J Perioper Pract 16:327–332

    Google Scholar 

  • Beach C, Croskerry P, Shapiro M (2003) Profiles in patient safety: emergency care transitions. Acad Emerg Med 10:364–367

    Article  Google Scholar 

  • Boockvar K, Fishman E, Kyriacou CK, Monias A, Gavi S, Cortes T (2004) Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Arch Internal Med 164:545–550

    Article  Google Scholar 

  • Carayon P, Schultz K, Hundt AS (2004) Righting wrong site surgery. Jt Comm J Qual Saf 30:405–410

    Google Scholar 

  • Carayon P, Gurses AP, Hundt AS, Ayoub P, Alvarado CJ (2005a) Performance obstacles and facilitators of healthcare providers. In: Korunka C et al (eds) Change and quality in human service work, vol 4. Hampp Publishers, Munchen, pp 257–276

  • Carayon P, Hundt AS, Alvarado CJ, Springman S, Borgsdorf A, Jenkins L (2005b) Implementing a systems engineering intervention for improved patient safety—example in outpatient surgery. In: Henriksen K et al (eds) Advances in patient safety: from research to implementation, vol 3. Agency for Healthcare Research and Quality, Rockville, MD, pp 305–321

  • Carayon P, Wetterneck TB, Hundt AS, Ozkaynak M, Ram P, DeSilvey J, Hicks B, Roberts TL, Enloe M, Sheth R, Sobande S (2005c) Observing nurse interaction with infusion pump technologies. In: Henriksen K et al (eds) Advances in patient safety: from research to implementation, vol 2. Agency for Healthcare Research and Quality, Rockville, MD, pp 349–364

  • Carayon P, Hundt A, Alvarado C, Springman S, Ayoub P (2006) Patient safety in outpatient surgery: the viewpoint of the healthcare providers. Ergonomics 49:470–485

    Article  Google Scholar 

  • Clancy CM (2006) Care transitions: a threat and an opportunity for patient safety. Am J Med Qual 21:415–417

    Article  Google Scholar 

  • Coleman EA, Berenson RA (2004) Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med 141:533–536

    Google Scholar 

  • Cook RI, Render M, Woods DD (2000) Gaps in the continuity of care and progress on patient safety. Br Med J 320:791–794

    Article  Google Scholar 

  • Cooper JB (1989) Do short breaks increase of decrease anesthetic risk? J Clin Anesth 1:228–231

    Article  Google Scholar 

  • Cooper JB, Long CD, Newbower RS, Philip JH (1982) Critical incidents associated with intraoperative exchanges of anesthesia personnel. Anesthesiology 56:456–461

    Article  Google Scholar 

  • Dovey SM, Meyers DS, Phillips RL, Green LA, Fryer GE, Galliher JM, Kappus J, Grob P (2002) A preliminary taxonomy of medical errors in family practice. Qual Saf Health Care 11:233–238

    Article  Google Scholar 

  • Drury J, Williams M (2002) A framework for role-based specification and evaluation of awareness support in synchronous collaborative applications. In: Paper presented at the proceedings of the 11th IEEE international workshops on enabling technologies: Infrastructure for Collaborative Enterprises, Pittsburgh, PA

  • Elder NC, Vonder Meulen MB, Cassedy A (2004) The identification of medical errors by family physicians during outpatient visits. Ann Fam Med 2:125–129

    Article  Google Scholar 

  • Endsley MR (1988) Situation awareness global assessment technique (SAGAT). In: Paper presented at the proceedings of the national aerospace and electronics conference

  • Endsley MR (1995) Toward a theory of situation awareness in dynamic systems. Hum Factors 37:32–64

    Article  Google Scholar 

  • Endsley MR (2000) Theoretical underpinnings of situation awareness: a critical review. In: Endsley MR, Garland DJ (eds) Situation awareness analysis and measurement. Lawrence Erlbaum Associates, Mahwah, pp 3–32

    Google Scholar 

  • Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, Khan A, van Walraven C (2004) Adverse events among medical patients after discharge from hospital. Can Med Assoc J 170:345–349

    Google Scholar 

  • Gaba DM, Howard SK, Jump B (1994) Production pressure in the work environment. California anesthesiologists’ attitudes and experiences. Anesthesiology 81:488–500

    Article  Google Scholar 

  • Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW (2000) Communication breakdown in the outpatient referral process. J Gen Intern Med 15:626–631

    Article  Google Scholar 

  • Henderson BA, Naveiras M, Butler N, Hertzmark E, Ferrufino-Ponce Z (2006) Incidence and causes of ocular surgery cancellations in an ambulatory surgical center. J Cataract Refract Surg 32:95–102

    Article  Google Scholar 

  • Hollnagel E, Woods DD (2005) Joint cognitive systems: foundations of cognitive systems Engineering. Taylor and Francis Group, Boca Raton

    Google Scholar 

  • Ivarsson B, Larsson S, Sjoberg T (2004) Postponed or cancelled heart operations from the patient’s perspective. J Nurs Manag 12:28–36

    Article  Google Scholar 

  • Matthews AL, Harvey CM, Schuster RJ, Durso FT (2002) Emergency physician to admitting physician handovers: an exploratory study. In: Human Factors and Ergonomics Society (ed). Proceedings of the human factors and ergonomics society 46th annual meeting. Human Factors and Ergonomics Society, Santa Monica, pp 1511–1515

  • Moore C, Wisnivesky J, Williams S, McGinn T (2003) Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 18:646–651

    Article  Google Scholar 

  • Perry S (2004) Transitions in care: studying safety in emergency department signovers. Focus Patient Saf 7:1–3

    Google Scholar 

  • Prince C, Salas E (2000) Team situation awareness, errors, and crew resource management: research integration for training guidance. In: Endsley MR, Garland DJ (eds) Situation awareness analysis and measurement. Lawrence Erlbaum Associates, Mahwah, NJ pp 325–347

    Google Scholar 

  • Roth EM, Christian CK, Gustafson M, Sheridan TB, Dwyer K, Gandhi TK, Zinner MJ, Dierks MM (2004) Using field observations as a tool for discovery: analyzing cognitive and collaborative demands in the operating room. Cogn Technol Work 6:148–157

    Article  Google Scholar 

  • Salas E, Prince C, Baker DP, Shrestha L (1995) Situation awareness in team performance: implications for measurement and training. Hum Factors 37(1):123–136

    Article  Google Scholar 

  • Schultz K, Carayon P, Hundt AS, Springman SR (2005a) Patient care process and information flow in outpatient surgery. In: Human Factors and Ergonomics Society (ed). Proceedings of the human factors and ergonomics society 49th annual meeting. Human Factors and Ergonomics Society, Santa Monica, pp 1469–1473

  • Schultz K, Carayon P, Hundt AS (2005b) A macroergonomic framework of awareness in transitions of care: application to the preoperative surgery process. In: Carayon P et al (eds) Human factors in organizational design and management-VIII. IEA Press, Santa Monica, pp 311–316

  • Smith K, Hancock PA (1995) Situation awareness is adaptive, externally directed consciousness. Hum Factors 37:137–148

    Article  Google Scholar 

  • Smith PC, Araya-Guerra R, Bublitz C, Parnes B, Dickinson LM, Van Vorst R, Westfall JM, Pace WD (2005) Missing clinical information during primary care visits. J Am Med Assoc 293:565–571

    Article  Google Scholar 

  • Wears RL, Perry SJ, Shapiro M, Beach C, Croskerry P, Behara R (2003) Shift changes among emergency physicians: best of times, worst of times. In: Human Factors and Ergonomics Society (ed). Proceedings of the human factors and ergonomics society 47th annual meeting. Human Factors and Ergonomics Society, Santa Monica, pp 1420–1423

  • Wears RL, Perry SJ, Eisenberg E, Murphy L, Shapiro M, Beach C, Croskerry P, Behara R (2004a) Transitions in care: signovers in the emergency department. In: Human Factors and Ergonomics Society (ed). Proceedings of the human factors and ergonomics society 48th annual meeting. Human Factors and Ergonomics Society, Santa Monica, pp 1625–1628

  • Wears RL, Perry SJ, Eisenberg E, Murphy L, Shapiro M, Beach C, Croskerry P, Behara R (2004b) Conceptual framework for studying shift changes and other transitions in care. In: Human Factors and Ergonomics Society (ed). Proceedings of the human factors and ergonomics society 48th annual meeting. Human Factors and Ergonomics Society, Santa Monica, pp 1615–1619

  • Weick KE, Sutcliffe KM (2001) Managing the unexpected: assuming high performance in an age of complexity. Jossey-Bass, San Francisco

    Google Scholar 

Download references

Acknowledgments

Funding provided by AHRQ Grant # P20 HS11561-01 (PI: Pascale Carayon) and AHRQ Institutional Training Grant #HS000083 (PI: Dennis Fryback).

Author information

Authors and Affiliations

  1. Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 610 Walnut Street, 575 WARF, Madison, WI 53726, USA

    Kara Schultz & Pascale Carayon

  2. Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 610 Walnut Street, 575 WARF, Madison, WI 53726, USA

    Kara Schultz, Pascale Carayon & Ann Schoofs Hundt

  3. Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center-F6, 600 Highland Avenue, Box 3272, Madison, WI 53792, USA

    Scott R. Springman

Authors
  1. Kara Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pascale Carayon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ann Schoofs Hundt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott R. Springman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kara Schultz.

Appendices

Appendix A: Shadowing tool

figure a

Appendix B: Dictation guide

Throughout your preoperative-related work today...

Did you experience any problems, delays, or frustrations with obtaining necessary patient documents or information?

If yes,

What type of documents/information was it (e.g., type of form, electronic vs. hardcopy)?

Where did the document/information come from or where was it supposed to come from (e.g., referring physician, origin of consult)?

Who delivered or was supposed to deliver the documents/information (e.g., patient, referring physician)?

Was there any documentation/information that was not available to you when you needed it?

If yes,

Why was the needed documentation/information not available?

How is this documentation/information obtained?

Who is responsible for getting this documentation/information?

Was there any documentation/information that was incomplete or not adequate?

If yes,

Please describe the problems with the documentation/information as to why it was incomplete or inadequate.

Please provide any additional comments concerning issues of information availability, access or flow.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schultz, K., Carayon, P., Hundt, A.S. et al. Care transitions in the outpatient surgery preoperative process: facilitators and obstacles to information flow and their consequences. Cogn Tech Work 9, 219–231 (2007). https://doi.org/10.1007/s10111-007-0081-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10111-007-0081-0

Keywords

Search

Navigation