The Unappreciated Challenges of Between-Unit Handoffs: Negotiating and Coordinating Across Boundaries.

Source

Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH.

Abstract

Although interest in studying and improving handoffs has grown considerably in recent years, a general tendency to treat handoff as a single type of activity has resulted in overlooking important variation and in understudying one consequential type: between-unit handoffs. Using the admission handoff between emergency departments and inpatient services as an example, this conceptual article identifies 2 distinguishing structural features of between-unit transitions and demonstrates how these features create negotiation and coordination challenges that are further complicated by several contextual factors. Between-unit handoffs are distinguished from within-unit handoffs because the former are triggered by patient conditions as opposed to shift schedules and entail working across organizational boundaries rather than within them. Consequently, between-unit handoffs are challenged by several contextual factors, including interprofessional differences, unequal distributions of power among units, frequent lack of established relationships among the involved parties, infrequent face-to-face communication, a lack of awareness of the other unit's state, and the fact that responsibility and control of patients are transferred separately. Implications for improvement are discussed.
Copyright © 2012. Published by Mosby, Inc.