Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes

Abstract

Objective: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related.

Background: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition.

Method: We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes.

Results: Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task.

Conclusion: Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

Keywords: care transitions and handoffs; communication and teamwork in health care; macroergonomics and the environment; system design and analysis; team cognition.

Figure 1

System-Process-Outcome Framework to Describe Handoffs Based on SEIPS 3.0 (Carayon et al., 2006; Carayon et al., 2014; Carayon et al., 2020)

Figure 2. Mean ENA Networks for (a) OR to PICU (inter-professional handoff), (b) OR to ICU (intra-professional handoff) and (c) Subtracted Mean (OR to PICU – OR to ICU)

Note. Network centroids of interviewees participating in the inter-professional, OR to PICU handoff are significantly different along x-axis from the interviewees participating in the intra-professional, OR to ICU handoff (p<0.001), but not significantly different along the y-axis (p=0.72). Abbreviations are as follow: OR = Operating room ICU = Intensive care unit PICU = Pediatric intensive care unit C.InfoExchange = Information exchange C.Assess = Assessment C.PlanDM = Planning and decision making WS.Person = Persons work system element WS.Task = Task work system element WS.TT = Tools/technologies work system element WS.Org = Organization work system element WS.PE = Physical environment work system element Outcome = Handoff outcome