Collaborating-or 'Selling' Patients? A Conceptual Framework for Emergency Department-to-Inpatient Handoff Negotiations

摘要

Handoffs that occur between units-such as admission handoffs between an emergency department (ED) and an inpatient unit-have received little attention in the burgeoning literature on patient handoffs. Yet such transitions are consequential in the care of vast numbers of patients. For example, despite the fact that half of all non-obstetric hospital admissions in the United States come through an ED, an extensive study of the handoff literature found that ED admissions were the subject of only 9 of more than 640 published items. Studies of within-unit handoffs, including shift and rotation changes, have dominated handoff research efforts, but there are limits to the applicability of such studies for improving between-unit transitions. Because between-unit handoffs entail the interaction of different specializations; the coordination of care across unit boundaries; and, typically, the physical movement of the patient, such transitions encounter a host of unique social and organizational factors not frequently involved in within-unit handoffs. For example, different medical or surgical specialists use different terminologies and orientations toward illness and treatment plans, thereby hindering communication efforts. Further complicating interactions are tensions, power imbalances, and stereotyping among health care specializations or patient care units and the infrequency of existing established relationships. In addition, organizational structures-such as routines, physical and communication infrastructures, and divisions of labor-feature prominently in such transitions, and yet the influence of such structures has not been fully investigated.