Information handover in time-critical work

ABSTRACT

Information transfer under time pressure and stress often leads to information loss. This paper studies the characteristics and problems of information handover from the emergency medical services (EMS) crew to the trauma team when a critically injured patient arrives to the trauma bay. We consider the characteristics of the handover process and the subsequent use of transferred information. Our goal is to support the design of technology for information transfer by identifying specific challenges faced by EMS crews and trauma teams during handover. Data were drawn from observation and video recording of 18 trauma resuscitations. The study shows how EMS crews report information from the field and the types of information that they include in their reports. Particular problems occur when reports lack structure, continuity, and complete descriptions of treatments given en route. We also found that trauma team members have problems retaining reported information. They pay attention to the items needed for immediately treating the patient and inquire about other items when needed during the resuscitation. The paper identifies a set of design challenges that arise during information transfer under time pressure and stress, and discusses characteristics of potential technological solutions.

REFERENCES

• 1: American College of Surgeons. 2005. Advanced Trauma Life Support® (ATLS®), 7th Edition, Chicago, IL.
• 2: Cheah, L-P., Amott, D. H., Pollard, J., and Watters, D. A. K. 2005. Electronic medical handover: Towards safer medical care. Med. J. Australia, 183, 7, 369--372.
• 3: Cook, R.I., Woods D.D., and Miller C. 1998. A Tale of Two Stories: Contrasting Views on Patient Safety. Chicago, IL: The Foundation.
• 4: Currie, J. 2002. Improving the efficiency of patient handover. Emergency Nurse, 10, 3, 24--27.
• 5: Emergency Medical Technician-Basic: National Standard Curriculum. Online at: http://www.nhtsa.dot.gov
• 6: Gawande, A. 2007. The checklist. The New Yorker, 83, 39, (December 10, 2007), 86--95.
• 7: Hopkins, A. 2000. Lessons from Longford: The Esso Gas Plant Explosion. Sydney: CCH.
• 8: Horn, J., Bell, M.D.D., and Moss, E. 2004. Handover of responsibility for the anaesthetised patient' opinion and practice. Anaesthesia, 59, 7, 658--663.
• 9: Kerr, M.P. 2002. A qualitative study of shift handover practice and function from a socio-technical perspective. J. Advanced Nursing, 37, 2, 125--134.
• 10: King, R.W. 1990. Safety in the Process Industries. Oxford: Butterworth-Heinemann.
• 11: McFetridge, B., Gillespie, M., Goode, D., and Melby, V. 2007. An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit. Nursing in Critical Care, 12, 6, 261--269.
• 12: National Trauma Data Bank Annual Report. 2008. Online at: http://www.facs.org/trauma/ntdb.html
• 13: Patterson, E. S., Roth, E. M., Woods, D. D., Chow, R., and Orlando, J. 2004. Handoff strategies in settings with high consequence for failure: Lessons for health care operations. International J. Qual. Health, 16, 2, 125--132.
• 14: Emily S. Patterson , David D. Woods, Shift Changes, Updates, and the On-Call Architecture in Space Shuttle Mission Control, Computer Supported Cooperative Work, v.10 n.3-4, p.317-346, December 2001 [doi>10.1023/A:1012705926828]
• 15: Reason, J.T. 2002. Combating omission errors through task analysis and good reminders. Quality & Safety in Health Care, 11, 1 (March 1 2002), 40--44.
• 16: Aleksandra Sarcevic , Ivan Marsic , Michael E. Lesk , Randall S. Burd, Transactive memory in trauma resuscitation, Proceedings of the ACM 2008 conference on Computer supported cooperative work, November 08-12, 2008, San Diego, CA, USA [doi>10.1145/1460563.1460597]
• 17: Scott, L.A., Brice, J.H., Baker, C.C., and Shen, P. 2003. An analysis of paramedic verbal reports to physicians in the emergency department trauma room. Prehospital Emergency Care, 7, 2, 247--251.
• 18: Smith, A. F., Pope, C., Goodwin, D., and Mort, M. 2008. Interprofessional handover and patient safety in anaesthesia. British J. Anaesthesia, 101, 3, 332--337.
• 19: Solet, D.J., Norvell, J.M., Rutan, G.H., and Frankel, R.M. 2005. Lost in translation: Challenges and opportunities in physician-to-physician communication during patient handoffs. Academic Medicine, 80, 12, 1094--1099.
• 20: Talbot, R., and Bleetman, A. 2007. Retention of information by emergency department staff at ambulance handover: Do standardised approaches work? Emergency Medicine J., 24, 8, 539--542.
• 21: Charlotte Tang , Sheelagh Carpendale, An observational study on information flow during nurses' shift change, Proceedings of the SIGCHI conference on Human factors in computing systems, April 28-May 03, 2007, San Jose, California, USA [doi>10.1145/1240624.1240661]
• 22: Thakore, S., and Morrison, W. 2001. A survey of the perceived quality of patient handover by ambulance staff in the resuscitation room. Emergency Medicine Journal, 18, 293--296.
• 23: Stephanie Wilson , Julia Galliers , James Fone, Not all sharing is equal: the impact of a large display on small group collaborative work, Proceedings of the 2006 20th anniversary conference on Computer supported cooperative work, November 04-08, 2006, Banff, Alberta, Canada [doi>10.1145/1180875.1180880]
• 24: Wilson, S., Galliers, J., and Fone, J. 2005. Medical handover: A study and implications for information technology. In Proceedings of HEPS 2005, 337--341.
• 25: Wu, A., Pronovost, P., and Morlock, L. 2002. ICU incident reporting systems. J. Critical Care, 17, 2 (June 2002), 86--94.

INDEX TERMS

Primary Classification:
  H. Information Systems
  H.5 INFORMATION INTERFACES AND PRESENTATION (I.7)
      H.5.3 Group and Organization Interfaces
          Subjects: Computer-supported cooperative work

Additional Classification:
  H. Information Systems
  H.1 MODELS AND PRINCIPLES
      H.1.2 User/Machine Systems
          Subjects: Human information processing

General Terms:
Design, Human Factors

Keywords:
communication, healthcare, information handover, teamwork, time-critical work, traumatic injury