Improving shift handovers between medical residents : the effect of information access cost, metacognition and media affordances
Date of Issue2014
School of Mechanical and Aerospace Engineering
The continuity of patient care and limited resident working hours routinize the handover of patients between doctors. Despite of the pivotal role to ensure quality of patient care, clinical handovers were found to be vulnerable episodes contributing to near misses, adverse events and waste of healthcare resources. Handovers can be conceptualized as a three-phase process, namely pre-handover, handover communication, and post-handover. Existing research, however, is largely limited to the communication phase, especially to the study of communication content. Little effort was made to study the information retrieval strategy during pre-handover and the effect of media during handover communication. This thesis therefore aims to propose a suitable framework for modeling the factors influencing the performance of pre-handover and handover communication; and to study experimentally the effects of information access cost, overconfidence bias and media affordances. This thesis includes an extensive review of clinical shift handovers, information retrieval strategy and media affordance, as well as four empirical studies to investigate the proposed research models. Study 1 explored medical residents’ handover practices in a university hospital. Study 2 adopted a laboratory setting to examine the underlying factors affecting the information retrieval strategy. Study 3 investigated medical residents’ information retrieval strategy in pre-handover. Study 4 examined the effect of media affordances on medical residents’ handover communication. With regard to the pre-handover phase, the results of quantitative and qualitative analyses across the studies showed that besides the well-documented factor - information access cost, the perceived accuracy of memory is another important determinant influencing the information retrieval strategy. Moreover, overconfidence affected medical residents’ pre-handover performance. With regard to the handover communication phase, the results of quantitative and qualitative analyses across the studies showed that reviewability (14% increase) and visual access to object of reference (12% increase) strongly supported the handover receivers’ memory retention of important patient information, and interactivity supported both memory retention (24% increase) and case comprehension (26% increase). Furthermore, the results provided contradicting evidence to the long-held recommendation that face to face handover is preferred to mediated communication. Being able to see other was found to affect neither memory retention nor case comprehension. This research is of both theoretical and practical significance. Theoretically, the research proposed two research models to describe various factors influencing the performance of pre-handover and handover communication. In particular, at the pre-handover phase, this research modeled the relationship between information access cost, overconfidence bias and medical residents’ information retrieval strategy. At the handover communication phase, this research modeled the relationship between the affordances of interactivity, reviewability, visual access of object of reference, visibility and medical residents’ handover communication performance. Moreover, this research provided empirical evidence for the causal relationships. Alongside the theoretical significance is a very practical concern. Singapore is aiming to become a leading medical hub in Asia and hospitals in Singapore are developing standard handover protocols to enhance patient safety. Results from this research provided practical implications for the development of handover tools and protocols.